Diabetes Insulin Therapy 4 — Questions and Answers
Question 1: An insulin-dependent patient plans to travel across multiple time zones. Which insulin type requires the most careful schedule adjustment?
- Rapid-acting insulin
- Long-acting basal insulin (Correct answer)
- Premixed insulin 70/30
- Inhaled insulin
Correct answer: Long-acting basal insulin
Long-acting basal insulin is time-sensitive; crossing time zones can disrupt the 24-hour dosing cycle, requiring careful scheduling to avoid gaps or overdose.
Question 2: Which of the following best describes insulin resistance in Type 2 diabetes?
- The pancreas produces no insulin
- Cells do not respond effectively to insulin's signal to take up glucose (Correct answer)
- Insulin degrades too quickly in the bloodstream
- The immune system destroys insulin molecules
Correct answer: Cells do not respond effectively to insulin's signal to take up glucose
Insulin resistance means peripheral tissues (muscle, fat, liver) fail to respond normally to insulin signaling, requiring higher insulin levels to achieve glucose uptake.
Question 3: A closed-loop insulin delivery system (artificial pancreas) differs from standard CSII by:
- Using oral insulin instead of injected insulin
- Automatically adjusting insulin delivery based on continuous glucose monitor readings (Correct answer)
- Delivering insulin only at mealtimes
- Requiring manual programming every 4 hours
Correct answer: Automatically adjusting insulin delivery based on continuous glucose monitor readings
Closed-loop systems integrate a CGM with an insulin pump and algorithm to automatically modulate basal insulin delivery in real time.
Question 4: Inhaled insulin (Afrezza) is contraindicated in patients with:
- Type 1 diabetes
- Chronic lung disease such as COPD or asthma (Correct answer)
- Renal impairment
- Obesity (BMI > 35)
Correct answer: Chronic lung disease such as COPD or asthma
Afrezza is contraindicated in patients with chronic lung disease because it can cause acute bronchospasm and decreased pulmonary function.
Question 5: What is the correct action if a patient accidentally injects double their usual insulin dose?
- Exercise vigorously to burn the extra glucose
- Consume carbohydrates immediately and monitor glucose closely (Correct answer)
- Administer glucagon preemptively
- Skip the next insulin dose to compensate
Correct answer: Consume carbohydrates immediately and monitor glucose closely
Immediate carbohydrate intake and close glucose monitoring are required to prevent or treat the hypoglycemia that will result from the excess insulin.
Question 6: The correction factor (sensitivity factor) in insulin therapy is used to:
- Determine how many units of insulin are needed per gram of carbohydrate
- Estimate how much one unit of insulin will lower blood glucose (Correct answer)
- Calculate the total daily insulin dose
- Adjust basal rates during illness
Correct answer: Estimate how much one unit of insulin will lower blood glucose
The correction factor tells patients how many mg/dL their glucose will drop per unit of rapid-acting insulin, enabling targeted correction doses.
Question 7: A patient with Type 1 diabetes is starting on an insulin pump. Which insulin type is exclusively used in most insulin pumps?
- NPH insulin
- Rapid-acting insulin (e.g., lispro, aspart, or glulisine) (Correct answer)
- Regular insulin only
- Long-acting basal insulin
Correct answer: Rapid-acting insulin (e.g., lispro, aspart, or glulisine)
Insulin pumps use only rapid-acting insulin, delivering small continuous doses for basal coverage and larger boluses for meals.
Diabetes Insulin Therapy 4
An insulin-dependent patient plans to travel across multiple time zones.
Which insulin type requires the most careful schedule adjustment?