Diabetes Education Certification Insulin Therapy & Administration 2 — Questions and Answers
Question 1: A patient using an insulin pen reports that the dose dial shows 20 units but the pen only delivered part of the dose before running out of insulin. What is the most likely explanation?
- The pen needle was too short
- The remaining insulin in the cartridge was less than the dialed dose (Correct answer)
- The patient injected too slowly
- The pen was stored incorrectly
Correct answer: The remaining insulin in the cartridge was less than the dialed dose
If the cartridge contains less insulin than the dialed dose, the pen will deliver only the remaining units, resulting in an incomplete dose.
Question 2: Which insulin type has the longest duration of action and is most commonly used as basal coverage?
- Regular insulin
- NPH insulin
- Insulin glargine (Lantus) (Correct answer)
- Insulin lispro (Humalog)
Correct answer: Insulin glargine (Lantus)
Insulin glargine is a long-acting analog with a relatively peakless, 24-hour duration, making it ideal for basal coverage.
Question 3: A patient with type 1 diabetes is sick with vomiting and unable to eat. How should the diabetes care team advise regarding basal insulin?
- Skip basal insulin entirely until eating resumes
- Continue basal insulin and monitor blood glucose frequently (Correct answer)
- Double the basal dose to prevent ketoacidosis
- Switch to an oral agent temporarily
Correct answer: Continue basal insulin and monitor blood glucose frequently
Basal insulin should be continued during illness because the body still requires background insulin to prevent ketoacidosis, even without carbohydrate intake.
Question 4: When rotating insulin injection sites, which anatomical region has the fastest absorption rate?
- Thigh
- Buttocks
- Abdomen (Correct answer)
- Upper arm
Correct answer: Abdomen
The abdomen has the fastest and most consistent insulin absorption due to its rich blood supply and minimal muscle interference.
Question 5: A patient asks why their physician prescribed insulin degludec (Tresiba) instead of insulin glargine. What is a key pharmacokinetic advantage of degludec?
- Faster onset of action
- Ultra-long duration up to 42 hours with a more stable PK profile (Correct answer)
- Can be mixed with rapid-acting insulin in the same syringe
- Lower risk of hypoglycemia at night compared to all other insulins
Correct answer: Ultra-long duration up to 42 hours with a more stable PK profile
Insulin degludec has an ultra-long half-life providing up to 42 hours of coverage, which allows for more flexible dosing timing.
Question 6: Which of the following practices is INCORRECT when using an insulin vial and syringe?
- Injecting air into the vial before withdrawing insulin
- Rolling cloudy insulin gently between palms before drawing
- Wiping the vial stopper with alcohol before each use
- Storing an open vial in the refrigerator at all times (Correct answer)
Correct answer: Storing an open vial in the refrigerator at all times
Open vials can be stored at room temperature for up to 28–30 days; refrigerator storage is required only for unopened vials or if room temperature exceeds 77–80°F.
Question 7: A patient on a basal-bolus regimen consistently has high blood glucose 2 hours after breakfast but normal readings before other meals. Which adjustment is most appropriate?
- Increase the bedtime basal dose
- Increase the pre-breakfast rapid-acting insulin dose (Correct answer)
- Switch from rapid-acting to regular insulin at dinner
- Decrease the pre-lunch rapid-acting insulin dose
Correct answer: Increase the pre-breakfast rapid-acting insulin dose
Post-breakfast hyperglycemia that is isolated to the morning period indicates that the pre-breakfast rapid-acting bolus dose is insufficient.
Diabetes Education Certification Insulin Therapy & Administration 2
A patient using an insulin pen reports that the dose dial shows 20 units but the pen only delivered part of the dose before running out of insulin.
What is the most likely explanation?