Diabetes Insulin Therapy 2 — Questions and Answers
Question 1: Which insulin type is most appropriate for covering mealtime glucose spikes?
- NPH insulin
- Glargine (Lantus)
- Lispro (Humalog) (Correct answer)
- Detemir (Levemir)
Correct answer: Lispro (Humalog)
Rapid-acting insulins like lispro are designed to match postprandial glucose rises due to their quick onset.
Question 2: A patient using an insulin pump (CSII) experiences a site infection. What is the most important immediate action?
- Increase the basal rate
- Change the infusion site and monitor for ketones (Correct answer)
- Switch to oral hypoglycemics
- Administer IV insulin
Correct answer: Change the infusion site and monitor for ketones
Infected pump sites must be changed immediately, and ketone monitoring is essential since pump occlusion can cause rapid DKA.
Question 3: What is the recommended storage temperature for an unopened vial of insulin?
- Room temperature (59–77°F)
- Refrigerated at 36–46°F (Correct answer)
- Frozen at 0°F
- Warmed to body temperature
Correct answer: Refrigerated at 36–46°F
Unopened insulin vials should be refrigerated between 36–46°F to maintain potency until the expiration date.
Question 4: The 'dawn phenomenon' in insulin-treated patients refers to:
- Hypoglycemia occurring at 3 AM
- Rising blood glucose in early morning due to counter-regulatory hormones (Correct answer)
- Insulin resistance worsening at sunset
- Nocturnal hypoglycemia followed by rebound hyperglycemia
Correct answer: Rising blood glucose in early morning due to counter-regulatory hormones
The dawn phenomenon is caused by early-morning surges in cortisol and growth hormone that increase hepatic glucose output.
Question 5: Which of the following is a sign of insulin lipohypertrophy?
- Redness and warmth at injection sites
- Hard, rubbery lumps under the skin at injection sites (Correct answer)
- Bruising after each injection
- Itching without visible skin changes
Correct answer: Hard, rubbery lumps under the skin at injection sites
Lipohypertrophy appears as fatty tissue buildup from repeated injections at the same site, causing erratic insulin absorption.
Question 6: A Type 1 diabetic patient is sick with a viral illness and unable to eat. What should they do with their insulin?
- Stop all insulin to avoid hypoglycemia
- Continue basal insulin and check ketones frequently (Correct answer)
- Double the mealtime dose to cover stress hyperglycemia
- Only take insulin if blood glucose exceeds 300 mg/dL
Correct answer: Continue basal insulin and check ketones frequently
Sick day rules require continuing basal insulin even without eating, as illness increases counter-regulatory hormones causing hyperglycemia.
Question 7: What does the term 'insulin stacking' mean?
- Mixing two types of insulin in one syringe
- Administering correction doses before a previous dose has fully peaked (Correct answer)
- Injecting insulin in layers at the same site
- Using basal and bolus insulin simultaneously
Correct answer: Administering correction doses before a previous dose has fully peaked
Insulin stacking occurs when correction doses are given too frequently, causing overlapping action and hypoglycemia.
Diabetes Insulin Therapy 2
Which insulin type is most appropriate for covering mealtime glucose spikes?