BC ADM Insulin Therapy 2 — Questions and Answers
Question 1: A patient on U-500 regular insulin requires dose conversion when switching to U-100 insulin. Which statement is correct regarding this transition?
- Divide the U-500 dose by 5 to get the equivalent U-100 units (Correct answer)
- Multiply the U-500 dose by 5 to get the equivalent U-100 units
- The total units remain the same regardless of concentration
- U-500 cannot be converted directly to U-100 insulin
Correct answer: Divide the U-500 dose by 5 to get the equivalent U-100 units
U-500 is 5 times more concentrated than U-100, so dividing the U-500 unit dose by 5 gives the equivalent number of units in U-100.
Question 2: Which insulin formulation provides the most consistent and predictable absorption with the least intra-patient variability?
- NPH insulin
- Regular insulin
- Insulin glargine U-300 (Correct answer)
- Insulin lispro
Correct answer: Insulin glargine U-300
Insulin glargine U-300 (Toujeo) demonstrates the least intra-patient pharmacokinetic variability among basal insulins due to its concentrated depot formation.
Question 3: A patient with type 1 diabetes uses a total daily dose (TDD) of 40 units. Using the 500 rule, what is the estimated insulin sensitivity factor (ISF)?
- 10 mg/dL per unit
- 12.5 mg/dL per unit (Correct answer)
- 25 mg/dL per unit
- 8 mg/dL per unit
Correct answer: 12.5 mg/dL per unit
The 500 rule: 500 ÷ TDD = ISF; 500 ÷ 40 = 12.5 mg/dL drop per unit of rapid-acting insulin.
Question 4: When initiating basal insulin in a person with type 2 diabetes, which titration approach is supported by clinical evidence?
- Increase by 2 units every 3 days until fasting glucose is 80–130 mg/dL (Correct answer)
- Increase by 10 units every week regardless of glucose readings
- Decrease by 2 units if any fasting glucose is above 180 mg/dL
- Titrate based solely on postprandial glucose values
Correct answer: Increase by 2 units every 3 days until fasting glucose is 80–130 mg/dL
The treat-to-target approach of increasing basal insulin by 2 units every 3 days until fasting glucose reaches 80–130 mg/dL is well-validated (e.g., INSIGHT trial).
Question 5: A patient develops lipohypertrophy at their preferred injection site. Which consequence is most clinically relevant?
- Accelerated insulin absorption leading to hypoglycemia
- Unpredictable insulin absorption causing glucose variability (Correct answer)
- Increased insulin degradation at the injection site
- Permanent destruction of subcutaneous insulin receptors
Correct answer: Unpredictable insulin absorption causing glucose variability
Lipohypertrophy alters insulin absorption kinetics, resulting in erratic uptake and unpredictable blood glucose excursions.
Question 6: Which of the following best describes the pharmacokinetic difference between insulin aspart and regular human insulin?
- Aspart has a longer duration of action than regular insulin
- Aspart has a faster onset and shorter duration than regular insulin (Correct answer)
- Regular insulin peaks earlier than aspart
- Both have identical time-action profiles
Correct answer: Aspart has a faster onset and shorter duration than regular insulin
Insulin aspart (rapid-acting) has an onset of ~15 min and duration of 3–5 hours, versus regular insulin onset of 30–60 min and duration of 5–8 hours.
Question 7: In a closed-loop insulin delivery system, the algorithm primarily adjusts which insulin component to maintain glucose in range?
- Correction bolus doses based on A1C
- Basal insulin rate based on continuous glucose sensor readings (Correct answer)
- Mealtime bolus doses without patient input
- Long-acting insulin injections administered daily
Correct answer: Basal insulin rate based on continuous glucose sensor readings
Closed-loop (artificial pancreas) systems automatically modulate the basal insulin infusion rate in response to real-time CGM data to maintain glycemic targets.
BC ADM Insulin Therapy 2
A patient on U-500 regular insulin requires dose conversion when switching to U-100 insulin.
Which statement is correct regarding this transition?