一位第一型糖尿病病人於 0800 皮下注射 NPH 胰島素。護理師應在哪個時間最密切監測與此胰島素作用高峰相關的低血糖？
A client with type 1 diabetes mellitus receives a subcutaneous dose of NPH insulin at 0800. At which time should the nurse monitor the client most closely for hypoglycemia related to the peak action of this insulin?
- A0830
- B2300
- C1400正確答案
- D0400 the following day翌日 0400
- C1400
正確答案是 C。NPH 是中效胰島素，起效約 1–2 小時、作用高峰約在注射後 4–12 小時、作用時間約 12–18 小時。0800 注射後，高峰區間對應 1200 至 2000，因此 1400（注射後 6 小時）是四個選項中唯一落在高峰內的時間，午餐前後至下午是低血糖風險最高的時段。A：0830 只過了 30 分鐘，NPH 尚未起效。B：2300 已是注射後 15 小時，高峰已過、作用漸退。D：翌日 0400 為注射後 20 小時，作用接近尾聲。護理重點：在高峰時段觀察顫抖、出汗、心悸、飢餓、意識改變等低血糖表現；確保病人按時進餐並安排午後點心；教導病人辨識低血糖並以 15 公克速效碳水化合物處理，15 分鐘後複測血糖。來源：American Diabetes Association, Insulin Basics（NPH onset, peak, duration）；Lilley, Pharmacology and the Nursing Process。
- A0830
錯誤。0830 距注射僅 30 分鐘，NPH 起效需約 1–2 小時，此時尚未開始作用，不是低血糖的高峰時段。
- B2300
錯誤。2300 為注射後 15 小時，已超過 4–12 小時的高峰區間，藥效正在減退。
- C · 正確答案1400
正確。1400 是注射後 6 小時，落在 NPH 4–12 小時的作用高峰內，是低血糖風險最高、最需密切監測的時間。
- D翌日 0400
錯誤。翌日 0400 為注射後 20 小時，NPH 作用已接近尾聲，並非高峰時段。
美國門診第一型糖尿病病人多已改用長效胰島素類似物作為基礎胰島素，NPH 相對少用；台灣仍常見 NPH（如 Humulin N、Insulatard）與預混胰島素。兩地對 NPH 高峰 4–12 小時的教學一致，台灣衛教則更常結合餐後血糖監測。
English explanation
Option C is correct. NPH is an intermediate-acting insulin with an onset of about 1 to 2 hours, a peak of about 4 to 12 hours after injection, and a duration of about 12 to 18 hours. After a dose given at 0800, the peak window falls between 1200 and 2000, so 1400, which is 6 hours after the injection, is the only listed time within the peak; the risk of hypoglycemia is highest around lunch and through the afternoon. Option A is incorrect because at 0830 only 30 minutes have passed and NPH has not yet begun to act. Option B is incorrect because 2300 is 15 hours after the dose, when the peak has passed and the effect is fading. Option D is incorrect because 0400 the next day is 20 hours after the dose, near the end of its action. During the peak, the nurse watches for tremor, sweating, palpitations, hunger, and changes in level of consciousness, makes sure meals and an afternoon snack are eaten on time, and teaches the client to treat hypoglycemia with 15 grams of fast-acting carbohydrate and to recheck the glucose in 15 minutes. Source: American Diabetes Association, Insulin Basics (NPH onset, peak, and duration); Lilley, Pharmacology and the Nursing Process.