Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

When should the first dose of subcutaneous insulin be administered during the transition from IV insulin?

1. Two hours before the insulin drip is discontinued

2. Four hours before the insulin drip is discontinued

3. Immediately following discontinuation of the drip

4. At bedtime on the day the drip is discontinued

The correct answer is: Two hours before the insulin drip is discontinued

Administering the first dose of subcutaneous insulin two hours before the discontinuation of the IV insulin drip ensures a seamless transition in providing insulin coverage. The timing is critical as it allows subcutaneous insulin to begin its action just as the IV insulin's effects are tapering off. This overlap helps to maintain stable blood glucose levels and prevents a potential spike due to the sudden withdrawal of insulin. Starting subcutaneous insulin too close to the end of the IV drip may not provide sufficient time for the subcutaneous insulin to take effect, which can result in inadequate glycemic control. Conversely, if subcutaneous insulin is initiated too far in advance of discontinuation, it may lead to overlapping insulin action, increasing the risk of hypoglycemia. Therefore, transitioning insulin in this manner is a practice grounded in the principles of pharmacokinetics and patient safety management, ensuring continued glucose control during the transition phase.