A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because
a. absorption is diminished by the first-pass effects in the liver.
b. absorption is faster when insulin is given subcutaneously.
c. digestive enzymes in the gastrointestinal tract prevent absorption.
d. the oral form is less predictable with more adverse effects.
ANS: C
Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given subcutaneously because it is desirable to have it absorb slowly.
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