Question

A client with type 1 diabetes has been prescribed 12 units of regular insulin and 34 units of NPH insulin in the morning. How should the nurse explain why two different types of insulin are required to control the client's blood glucose?

1. “The different onsets and peaks of the two types provide better overall glucose control.”
2. “NPH prevents regular insulin from being broken down in the body, allowing the use of a lower dose.”
3. “The combination negates the risk of adverse effects that would likely accompany a single, larger dose..”
4. “NPH stimulate the pancreas to produce more insulin, while regular insulin provides your body’s short term needs.”

2. A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?

1. Between 8:30 AM and 9:30 AM
2. Between 10 AM and 12 noon
3. Between 2 PM and 4 PM
4. Between 12 noon and 8 PM

3.

What instructions should the nurse give to a client with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide?

1. “It is less potent, so you’ll likely be prescribed a larger dose.”
2. “Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication.”
3. “It has a greater effect and is longer lasting, so you’ll be prescribed itevery other day.”
4. “The two medications are fundamentally similar, but some clients respond better to one than the other.”

Answer 1

1.Intermediate acting Insulin(NPH)- onset of action- 1.5- 4hrs, peak- 4-12 hrs, duration-12-18 hrs

Long acting insulin(regular insulin)-onset of action-0.8-4hrs, peak no pronounced peak, duration-24+ hrs

Split-mix dose of Regular (long-acting)and NPH insulin (intermediate-acting)provide usually administered before breakfast in the morning or at the dinner , these two injections provide coverage for 24 Hrs and helps to control blood glucose levels between meals and overnight. Therefore, different onset and peaks provide better overall glucose control. Hence, Option A is the correct answer

Combination therapy is prescribed to provide normal gycemic state for patients and preventing side effects from hyperglycemia and hypoglycemia. Hence, Options B, C, D are incorrect answers

2.Rapid acting insulin preperations(lispro) onet of action-10-30 minutes, peak- 30 minutes- 3hrs, duration- 3-5 hrs

To control postprandial blood glucose levels, the timing of rapid and short acting insulin in relation to meals is crucial. Rapid acting insulin analogs such as Lispro(Humalog) has onset of action of approximately 15 minutes and it also mimics natural insulin secretion which occurs during and after meals. Hence, option A is the answer 8:30-9:30 AM

The other options does not match with the mechanism of action of Lispro, hence Options B,C and D are incorrect answers

3.Repaglinide has rapid onset of action and shorter duration of action, when taken prior to meals, hence you need to eat immediately soon after taking medications, othervise client will go in hypoglycemia. Hence, option B is the answer

Glyburide(sulphonylureas) stimulate release of insulin from pancreatic islets and is more potent than repaglinide(meglinitides),which causes rapid and short-lived insulin from the pancreas, hence , Options A, C and D are wrong answers