BC ADM Insulin Therapy 3

Question 1

A patient on basal-bolus insulin therapy has consistently elevated 2-hour postprandial glucose after dinner but acceptable fasting and pre-meal values. The most appropriate adjustment is:

Accepted Answer

Increase the pre-dinner rapid-acting insulin dose

Answer

Isolated postprandial hyperglycemia after a specific meal indicates insufficient mealtime (prandial) insulin coverage for that meal.

Question 2

Which factor most significantly reduces insulin absorption rate from a subcutaneous injection?

Accepted Answer

Injection into a lipohypertrophic site

Answer

Lipohypertrophic tissue is fibrotic and poorly vascularized, substantially slowing and unpredictably altering insulin absorption.

Question 3

The 'dawn phenomenon' in diabetes refers to:

Accepted Answer

Early morning hyperglycemia due to physiologic rise in counter-regulatory hormones

Answer

The dawn phenomenon is caused by early-morning surges in growth hormone and cortisol that increase hepatic glucose production, raising fasting blood glucose.

Question 4

A patient using CSII (insulin pump) therapy develops diabetic ketoacidosis. The most likely pump-related cause is:

Accepted Answer

Catheter occlusion or site failure interrupting insulin delivery

Answer

Catheter kinking, dislodgment, or site occlusion can completely interrupt subcutaneous insulin delivery, rapidly leading to DKA since pumps use only rapid-acting insulin.

Question 5

When calculating an insulin-to-carbohydrate ratio (ICR), the '450 rule' is used instead of the '500 rule' in which scenario?

Accepted Answer

When the patient uses regular (short-acting) insulin for meals

Answer

The 450 rule is applied when regular (human) insulin is used for meal coverage because its slower onset requires a slightly different ratio than rapid-acting analogs.

(BC ADM) Advanced Diabetes Management Certification Practice Test

(BC ADM) Advanced Diabetes Management Certification Practice Test

BC ADM Insulin Therapy 3