Diabetes Education Certification Insulin Therapy & Administration 3 — Questions and Answers
Question 1: A patient using an insulin pump reports unexplained hyperglycemia for 3 consecutive hours. After ruling out illness, what should be checked first?
- The patient's carbohydrate intake log
- The infusion site and catheter for kinking or occlusion (Correct answer)
- The pump's correction factor setting
- Whether the patient napped after lunch
Correct answer: The infusion site and catheter for kinking or occlusion
Infusion site problems such as kinking, occlusion, or lipohypertrophy are the most common causes of unexplained pump hyperglycemia.
Question 2: What is the recommended maximum volume for a single subcutaneous insulin injection to ensure proper absorption?
- 0.5 mL
- 1 mL (Correct answer)
- 1.5 mL
- 2 mL
Correct answer: 1 mL
Subcutaneous injections should not exceed 1 mL to avoid pooling, discomfort, and unpredictable absorption.
Question 3: A patient with type 2 diabetes on metformin requires the addition of insulin. Which starting regimen is most consistent with current guidelines?
- Twice-daily premixed insulin 70/30
- Basal insulin at bedtime with continuation of oral agents (Correct answer)
- Rapid-acting insulin before each meal only
- Immediate conversion to a full basal-bolus regimen
Correct answer: Basal insulin at bedtime with continuation of oral agents
Current ADA guidelines recommend starting with basal insulin added to existing oral agents as the simplest and most effective first insulin strategy.
Question 4: Which patient behavior is most likely to cause lipohypertrophy at injection sites?
- Injecting at a 45-degree angle
- Reusing the same injection site repeatedly without rotation (Correct answer)
- Using U-100 insulin instead of U-200
- Injecting at room temperature rather than refrigerator temperature
Correct answer: Reusing the same injection site repeatedly without rotation
Lipohypertrophy results from repeated trauma and insulin exposure to the same fatty tissue, causing abnormal growth that impairs absorption.
Question 5: When converting a patient from twice-daily NPH to once-daily insulin glargine, what is the typical starting dose conversion ratio?
- Increase the total NPH dose by 20%
- Use 80% of the total daily NPH dose as glargine (Correct answer)
- Use the same total daily NPH dose as glargine
- Use only the bedtime NPH dose as glargine
Correct answer: Use 80% of the total daily NPH dose as glargine
Converting from NPH to glargine typically involves starting at 80% of the total daily NPH dose to reduce hypoglycemia risk, then titrating to target.
Question 6: A patient on continuous subcutaneous insulin infusion (CSII) needs to undergo an MRI. What is the standard recommendation for the insulin pump?
- Keep the pump running but move it to the arm
- Remove the pump and administer subcutaneous injections during and after the procedure (Correct answer)
- Switch to oral glucose-lowering medications for the day
- Suspend the pump basal rate 30 minutes before imaging
Correct answer: Remove the pump and administer subcutaneous injections during and after the procedure
Insulin pumps contain metal components and electronics that can malfunction or be damaged in an MRI environment, so the pump must be removed.
Question 7: What insulin concentration is found in most standard U.S. insulin products, and what does 'U-100' mean?
- 100 mg of insulin per mL
- 100 units of insulin per mL (Correct answer)
- 100 mcg of insulin per mL
- 100 mmol of insulin per mL
Correct answer: 100 units of insulin per mL
U-100 means there are 100 units of insulin per milliliter, which is the standard concentration used in the United States.
Diabetes Education Certification Insulin Therapy & Administration 3
A patient using an insulin pump reports unexplained hyperglycemia for 3 consecutive hours.
After ruling out illness, what should be checked first?