spectrum comparison
Insulin Types: Rapid vs Short vs Intermediate vs Long — Onset, Peak, Duration Chart
The NCLEX gives you a time stamp — "NPH at 0800" — and expects you to calculate when hypoglycemia hits. If you confuse NPH's 4–12 hour peak with glargine's peakless profile, you'll monitor at the wrong time and miss the crash.
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Practice 28 NCLEX-style questions
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Progression4 stages
Progression — 4 stages
Rapid-Acting
Onset · peak · duration- Onset 15 min, peak ~1 hr, lasts 3–4 hr
Key features- Clear solution
- Lispro, aspart, glulisine
Nursing focus- ★Give with meal — food must be present
- When mixing: draw up clear before cloudy
Hypoglycemia response- 15 g fast carbs
- Recheck glucose in 15 min
Short (Regular)
Onset · peak · duration- Onset 30 min, peak 2–3 hr, lasts 5–8 hr
Key features- Clear solution
- Only insulin given IV (e.g., DKA)
Nursing focus- Give 30 min before meals
- When mixing: draw up clear before cloudy
Hypoglycemia response- 15 g fast carbs
- Recheck glucose in 15 min
Intermediate (NPH)
Onset · peak · duration- Onset 1–2 hr, peak 4–12 hr, lasts ~16 hr
Key features- ★Cloudy — gently roll to mix, never shake
- Peak 4–12 hr = hypoglycemia window
Nursing focus- When mixing: draw up clear before cloudy
- Watch hypoglycemia at peak (afternoon)
Hypoglycemia response- 15 g fast carbs
- Recheck glucose in 15 min
Long-Acting
Onset · peak · duration- ★Onset 1–2 hr, NO peak, lasts ~24 hr
Key features- Clear solution
- Once-daily basal coverage
- Do not mix with other insulins
Nursing focus- Give same time daily
Hypoglycemia response- 15 g fast carbs
- Recheck glucose in 15 min
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Clinical Pearl
Clear before cloudy for mixing; glargine is clear but never mix — peakless means no predictable hypo window.
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