BC ADM Insulin Therapy 4 — Questions and Answers
Question 1: Which statement about insulin storage is most accurate for clinical practice?
- Opened insulin vials must always be refrigerated to maintain potency
- Unopened insulin should be refrigerated; in-use insulin can be kept at room temperature up to 28–30 days (Correct answer)
- Insulin loses potency within 24 hours once removed from refrigeration
- All insulin formulations can be stored at room temperature indefinitely
Correct answer: Unopened insulin should be refrigerated; in-use insulin can be kept at room temperature up to 28–30 days
Unopened insulin should be refrigerated (36–46°F); once opened, most formulations remain stable at room temperature (up to ~77°F) for 28–30 days depending on the product.
Question 2: A patient with type 2 diabetes on premixed insulin 70/30 twice daily has good fasting glucose but high post-lunch values. The most physiologically rational adjustment is:
- Add a rapid-acting insulin dose before lunch (Correct answer)
- Increase the morning 70/30 dose to cover lunch better
- Switch to basal insulin only
- Add metformin to suppress postprandial hepatic glucose
Correct answer: Add a rapid-acting insulin dose before lunch
Premixed 70/30 provides coverage mainly for breakfast and dinner; adding a separate rapid-acting dose at lunch directly addresses the uncontrolled midday postprandial rise.
Question 3: The pharmacologic rationale for combining insulin degludec with liraglutide (IDegLira) includes:
- Liraglutide amplifies basal insulin's effect on hepatic glucose suppression only at night
- GLP-1 agonist activity mitigates insulin-associated weight gain and reduces hypoglycemia risk (Correct answer)
- Degludec accelerates GLP-1 receptor activation in beta cells
- The combination prevents insulin antibody formation
Correct answer: GLP-1 agonist activity mitigates insulin-associated weight gain and reduces hypoglycemia risk
GLP-1 receptor agonists promote satiety and weight loss while stimulating glucose-dependent insulin secretion, counteracting insulin-associated weight gain and reducing hypoglycemia risk.
Question 4: Insulin resistance in a hospitalized patient is MOST likely to increase insulin requirements due to:
- Decreased renal insulin clearance during illness
- Counter-regulatory hormone surges during physiologic stress (Correct answer)
- Increased subcutaneous fat deposition from IV dextrose
- Accelerated hepatic insulin degradation during acute illness
Correct answer: Counter-regulatory hormone surges during physiologic stress
Physiologic stress triggers release of epinephrine, cortisol, glucagon, and growth hormone, causing marked insulin resistance and increased glucose production.
Question 5: A patient using an insulin pen forgets to prime (perform an air shot) before injection. The most likely consequence is:
- Air embolism from subcutaneous air injection
- Delivery of an inaccurate (smaller) insulin dose (Correct answer)
- Accelerated insulin crystallization in the cartridge
- Needle clogging from insulin precipitation
Correct answer: Delivery of an inaccurate (smaller) insulin dose
Failure to prime the pen needle can result in air displacement within the pen mechanism, leading to delivery of less insulin than dialed.
Question 6: Which insulin regimen most closely mimics physiologic insulin secretion in type 1 diabetes?
- Once-daily long-acting insulin alone
- Twice-daily premixed 70/30 insulin
- Basal-bolus regimen with long-acting basal plus rapid-acting insulin at each meal (Correct answer)
- NPH insulin three times daily
Correct answer: Basal-bolus regimen with long-acting basal plus rapid-acting insulin at each meal
Basal-bolus therapy with a long-acting insulin providing background coverage plus rapid-acting analogs at mealtimes best replicates normal pancreatic insulin secretion patterns.
Question 7: When rotating insulin injection sites, the clinician should advise that absorption is fastest from which anatomic location?
- Outer thigh
- Upper outer arm
- Abdomen (periumbilical region excluded) (Correct answer)
- Upper buttock
Correct answer: Abdomen (periumbilical region excluded)
Subcutaneous abdominal tissue has the most vascular supply and least connective tissue of common injection sites, making insulin absorption fastest there.
BC ADM Insulin Therapy 4
Which statement about insulin storage is most accurate for clinical practice?