A patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin?

Choice A rationale Insulin glulisine is a rapid-acting insulin. Its onset of action is approximately 10 to 15 minutes, with a peak effect in about 30 to 90 minutes. It is typically administered immediately before or after a meal to manage postprandial glucose excursions. Rapid-acting insulins are used to mimic the natural insulin response to food intake. Choice B rationale Insulin isophane suspension (NPH) is an intermediate-acting insulin. It has a slower onset and longer duration of action compared to rapid- or short-acting insulins. Its onset is approximately 1 to 2 hours, with a peak effect in 4 to 12 hours. It is used to provide basal insulin coverage between meals and overnight. Choice C rationale Insulin detemir is a long-acting insulin. Its onset of action is gradual, typically starting 1 to 2 hours after administration, and it provides a steady, peakless glucose-lowering effect that can last for up to 24 hours. This type of insulin is designed to provide a continuous, basal level of insulin throughout the day or night. Choice D rationale Regular insulin is a short-acting insulin. It has an onset of action of 30 to 60 minutes, a peak effect in 2 to 4 hours, and a duration of 5 to 8 hours. It is used to cover meals and is the only insulin that can be administered intravenously in clinical settings for rapid glucose control.