Question

You are caring for K.W a 25-year-old female who is being discharged from the hospital after 3 days for control of her glucose levels. This morning fasting blood sugar was 145 mg/ dL and HbA1C 8.8%. The provider prescribed lispro 4 times daily, NPH daily, and glargine insulin 30 units at bedtime. What are the differences between lispro insulin, NPH insulin, and glargine insulin? Why would they be prescribed together? What are the peak times and duration for lispro and glargine insulins? Why is it important to know when insulin peaks? W states she knows people who take regular insulin before they eat. What is the difference between regular insulins and the insulins that K.W is prescribed? Describe the assessment and nursing interventions that are appropriate for this patient. Include rationale for each. What should be included in teaching for this patient? Include the storage of insulin. What is the guideline related to mixing of insulin? What types of insulin can be mixed together? What types cannot be mixed together?

Answer 1

Lispro (humalog) has recombinant DNA origin. It is a human insulin analogue made by reversal of the amino acids at positions 28 and 29 on the human insulin B chain.It is fast-acting insulin used to control high blood sugar in adults and children with diabetes mellitus.

Glargine(lantus) is long-acting human insulin analog. It improve glycemic control in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus.

NPH also known as neutral protamine hagedorn insulin.

The main difference between glargine, lispro and NPH is based on time taken to lower insulin levels. Glargine is long acting insulin, lispro is fast acting insulin and NPH is intermediate acting insulin. Lispro needs to be taken 15 min before meal, NPH 90 min before meal. Glargine is taken once daily in morning.