A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply).

Choice A rationale: An external insulin pump is a device designed to mimic the normal function of the pancreas. It provides a continuous, basal infusion of rapid-acting or regular insulin subcutaneously to maintain a steady blood glucose level. The client can then manually administer a bolus dose before meals to cover the carbohydrate intake, providing greater flexibility and precise glucose management.
Choice B rationale: Insulin pumps use rapid-acting or regular insulin, not NPH insulin. NPH is an intermediate-acting insulin, and its delayed and prolonged action is not suitable for the precise, continuous, and meal-time dosing regimen of an insulin pump. Pumps require fast-acting insulin to manage immediate glucose fluctuations.
Choice C rationale: Insulin pumps are external devices and are not surgically attached to the pancreas. They are worn on the body and deliver insulin into the subcutaneous tissue through a small catheter. The pancreas is an internal organ, and this type of surgical intervention is not a feature of standard insulin pump therapy.
Choice D rationale: The pump uses rapid-acting or regular insulin, not NPH insulin. While it does provide a continuous infusion, the client still needs to manually monitor their blood glucose levels and adjust their bolus doses accordingly. The pump itself does not continuously monitor blood glucose levels without an integrated continuous glucose monitor (CGM) system, which is a separate but often used device.

Choice A rationale: Insulin lispro (Humalog) is a rapid-acting insulin analog. Its amino acid sequence has been modified to allow for rapid absorption from the injection site into the bloodstream. This modification prevents the formation of hexamers, which are slowly absorbed, allowing the insulin to become biologically active within 15 minutes of administration.
Choice B rationale: Regular insulin, a short-acting type, typically has an onset of action of 30 to 60 minutes. Intermediate-acting insulins like NPH have a much longer onset, starting around 1 to 2 hours. Insulin lispro's rapid action is designed to be taken with meals to control postprandial hyperglycemia, which begins immediately after eating.
Choice C rationale: An onset of 80 minutes falls outside the typical time frame for both rapid and short-acting insulins. The pharmacokinetics of insulin lispro are specifically engineered for a quick onset to coincide with mealtime glucose spikes, and its action is not delayed for over an hour.
Choice D rationale: The peak effect of insulin lispro is around 1 to 2 hours, but its onset is much faster. Long-acting insulins like glargine (Lantus) have a much more prolonged effect, with a duration that can extend to 24 hours, but they lack a distinct peak. The 3 to 5 hour period is too long for the onset of a rapid-acting insulin.