A patient with diabetes is starting on insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

Choice A reason: Lispro (Humalog) is a type of insulin that is used for mealtime coverage. It is a rapid-acting insulin that starts to work within 15 minutes, peaks in about an hour, and lasts for 2 to 4 hours. It mimics the natural insulin response to food intake, and helps to lower the blood glucose level after meals. The nurse will discuss using lispro for mealtime coverage, and instruct the patient to inject it within 15 minutes before or after eating.

Choice B reason: NPH (Humulin N) is a type of insulin that is not used for mealtime coverage. It is an intermediate-acting insulin that starts to work within 2 to 4 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours. It provides a steady background of insulin throughout the day, and helps to control the blood glucose level between meals and overnight. The nurse will discuss using NPH for basal coverage, and instruct the patient to inject it once or twice a day, usually in the morning and/or evening.

Choice C reason: Detemir (Levemir) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using detemir for basal coverage, and instruct the patient to inject it once or twice a day, depending on the individual needs.

Choice D reason: Glargine (Lantus) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using glargine for basal coverage, and instruct the patient to inject it once a day, usually at the same time every day.

Choice A reason: Cushing's syndrome is caused by excess cortisol, a type of glucocorticoid hormone, in the body. This can result from overproduction of cortisol by the adrenal glands, or from prolonged use of corticosteroid medications. Elevated glucocorticoid level is the correct alteration in endocrine function for this condition.

Choice B reason: Decreased aldosterone level is not related to Cushing's syndrome. Aldosterone is another hormone produced by the adrenal glands, but it regulates the balance of sodium and potassium in the body. Decreased aldosterone level can cause low blood pressure, dehydration, and electrolyte imbalance.

Choice C reason: Elevated aldosterone secretion is also not related to Cushing's syndrome. Elevated aldosterone secretion can cause high blood pressure, fluid retention, and hypokalemia (low potassium level). This condition is known as hyperaldosteronism or Conn's syndrome.

Choice D reason: Diminished glucocorticoid level is the opposite of Cushing's syndrome. Diminished glucocorticoid level can cause low blood sugar, fatigue, weight loss, and poor stress response. This condition is known as Addison's disease or adrenal insufficiency.