Insulin Therapy Flashcards

A patient with CKD stage 4 (eGFR 22 mL/min) requires insulin dose adjustment because:

Answer: Reduced renal insulin clearance prolongs insulin action and increases hypoglycemia risk

The kidneys clear approximately 30–40% of circulating insulin; as renal function declines, insulin half-life is prolonged, increasing hypoglycemia risk and requiring dose reduction.

Which technique most effectively prevents insulin leakage after subcutaneous pen injection?

Answer: Hold the pen in place for 10 seconds after delivering the full dose before withdrawing

Keeping the needle in place for at least 10 seconds after dose delivery allows the insulin to disperse and prevents backflow through the needle track.

Intravenous insulin infusion protocols in the ICU are preferred over subcutaneous insulin primarily because IV administration:

Answer: Allows precise, titratable glucose control with rapid dose adjustments

IV insulin has immediate onset and offset, enabling precise glycemic control with rapid titration in response to the rapidly changing metabolic state of critically ill patients.

A patient is prescribed concentrated insulin glargine U-300. Compared to U-100 glargine, which statement is accurate?

Answer: U-300 glargine has a flatter, more prolonged action profile than U-100 glargine

U-300 glargine forms a more compact subcutaneous depot that dissolves more slowly, yielding a flatter pharmacodynamic profile and longer duration (up to 36 hours) than U-100 glargine.

The extended-release insulin icodec (once-weekly basal insulin) achieves its prolonged half-life primarily through:

Answer: Strong reversible binding to albumin via a fatty acid chain, reducing free insulin fraction

Insulin icodec contains a C20 fatty di-acid moiety that allows strong, reversible albumin binding, dramatically reducing free insulin and extending its half-life to ~196 hours.

A patient switches from NPH insulin given twice daily to insulin detemir. The diabetes care specialist should counsel that detemir:

Answer: May require twice-daily dosing due to its shorter duration compared to other basal analogs

Insulin detemir's duration is dose-dependent and shorter than glargine or degludec; many patients, especially those on lower doses, require twice-daily administration for adequate 24-hour coverage.

During sick-day management for a patient with type 1 diabetes, insulin should be:

Answer: Continued or increased as needed, with frequent glucose and ketone monitoring

Counter-regulatory hormones during illness increase insulin requirements; insulin should be continued with supplemental correction doses, guided by frequent glucose and ketone checks to prevent DKA.