Insulin Therapy Flashcards

Which insulin formulation has the longest duration of action?

Answer: Insulin degludec (Tresiba)

Degludec (Tresiba) has an ultra-long duration exceeding 42 hours, providing very stable basal coverage with minimal peak.

A patient's fasting blood glucose is consistently elevated despite adequate evening basal insulin. The most likely explanation is:

Answer: The Somogyi effect — nocturnal hypoglycemia followed by rebound

The Somogyi effect (rebound hyperglycemia) occurs when nocturnal hypoglycemia triggers counter-regulatory hormone release, raising morning glucose.

When mixing NPH and regular insulin in one syringe, which should be drawn up first?

Answer: Regular (clear) first

Clear before cloudy — regular insulin is drawn first to prevent contaminating the clear vial with NPH, which would alter its action profile.

What is the primary advantage of using an insulin-to-carbohydrate ratio (ICR)?

Answer: It allows individualized mealtime dosing based on carbohydrate intake

The ICR enables patients to calculate precise mealtime bolus doses based on the actual carbohydrates they plan to consume.

A patient using glargine (Lantus) reports a painful burning sensation at injection. The most likely cause is:

Answer: Injecting too rapidly or insufficient subcutaneous depth

Glargine has an acidic pH that can cause a burning sensation, especially when injected too quickly or superficially.

Which factor most significantly increases insulin absorption rate?

Answer: Exercising the injected limb immediately after injection

Exercise increases blood flow to the injected muscle, dramatically accelerating subcutaneous insulin absorption and raising hypoglycemia risk.

For a patient with Type 2 diabetes starting basal insulin, the typical starting dose is:

Answer: 10 units once daily or 0.1–0.2 units/kg/day

ADA guidelines recommend starting basal insulin at 10 units/day or 0.1–0.2 units/kg/day, then titrating based on fasting glucose.