Diabetes Insulin Therapy 3

Question 1

Which insulin formulation has the longest duration of action?

Accepted Answer

Insulin degludec (Tresiba)

Answer

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

Question 2

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

Accepted Answer

The Somogyi effect — nocturnal hypoglycemia followed by rebound

Answer

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

Question 3

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

Accepted Answer

Regular (clear) first

Answer

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

Question 4

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

Accepted Answer

It allows individualized mealtime dosing based on carbohydrate intake

Answer

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

Question 5

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

Accepted Answer

Injecting too rapidly or insufficient subcutaneous depth

Answer

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

Diabetes Practice Test