Diabetes Insulin Therapy 5 — Questions and Answers
Question 1: Which insulin requires a prescription but can be purchased over the counter at most US pharmacies without prior authorization?
- Insulin glargine (Lantus)
- Regular human insulin (ReliOn) at Walmart (Correct answer)
- Insulin degludec (Tresiba)
- Insulin aspart (NovoLog)
Correct answer: Regular human insulin (ReliOn) at Walmart
Regular human insulin (such as ReliOn brand) is available OTC at Walmart and some other pharmacies at low cost, though analog insulins require a prescription.
Question 2: Insulin glargine (Lantus) should NOT be mixed with other insulins because:
- It contains zinc, which inactivates other insulins
- Its acidic pH can alter the pharmacokinetics of the mixture (Correct answer)
- It degrades rapidly when exposed to other insulin molecules
- Mixing extends its duration beyond 42 hours
Correct answer: Its acidic pH can alter the pharmacokinetics of the mixture
Glargine's acidic pH (approximately 4) is neutralized when mixed, disrupting the microprecipitate that creates its prolonged, peakless absorption.
Question 3: A patient with Type 1 diabetes on MDI wants to reduce hypoglycemia risk overnight. The best strategy is:
- Skip basal insulin on exercise days
- Use a continuous glucose monitor with low-glucose suspend feature (Correct answer)
- Increase carbohydrate intake at every meal
- Switch from glargine to NPH for more predictable peaks
Correct answer: Use a continuous glucose monitor with low-glucose suspend feature
A CGM with low-glucose suspend automatically pauses insulin delivery when glucose falls, significantly reducing nocturnal hypoglycemia.
Question 4: Which of the following correctly describes 'basal-bolus' insulin therapy?
- Two doses of premixed insulin given at breakfast and dinner
- Long-acting insulin for background control plus rapid-acting insulin at mealtimes (Correct answer)
- Continuous IV insulin infusion titrated to glucose readings
- NPH insulin given twice daily without mealtime coverage
Correct answer: Long-acting insulin for background control plus rapid-acting insulin at mealtimes
Basal-bolus therapy mimics normal pancreatic function using a long-acting insulin for steady background coverage and rapid-acting insulin to cover meals.
Question 5: Severe hypoglycemia requiring assistance from another person should be treated first with:
- Oral glucose gel if the patient can swallow safely
- Glucagon injection or nasal glucagon (Baqsimi) if the patient cannot swallow (Correct answer)
- IV dextrose as the only acceptable treatment outside a hospital
- Additional rapid-acting insulin to stabilize glucose swings
Correct answer: Glucagon injection or nasal glucagon (Baqsimi) if the patient cannot swallow
When a patient is unconscious or cannot swallow, glucagon (injectable or intranasal) is the first-line emergency treatment to raise blood glucose.
Question 6: A patient's HbA1c remains above target despite adequate basal insulin. The next recommended step per ADA guidelines is:
- Increase the basal insulin dose until fasting glucose is below 70 mg/dL
- Add mealtime bolus insulin starting with the largest meal (Correct answer)
- Switch to an oral hypoglycemic agent
- Add a second long-acting insulin injection
Correct answer: Add mealtime bolus insulin starting with the largest meal
When basal insulin is optimized but HbA1c remains elevated, postprandial glucose is the likely driver and a mealtime bolus should be added, starting with the largest meal.
Question 7: Which statement about U-500 regular insulin is correct?
- It is 5 times more concentrated than standard U-100 insulin (Correct answer)
- It has a more rapid onset than standard U-100 regular insulin
- It is primarily used for Type 1 diabetes patients
- It cannot be used in insulin pumps
Correct answer: It is 5 times more concentrated than standard U-100 insulin
U-500 insulin contains 500 units per mL, making it 5 times more concentrated than U-100, and is used for highly insulin-resistant patients requiring very large doses.
Diabetes Insulin Therapy 5
Which insulin requires a prescription but can be purchased over the counter at most US pharmacies without prior authorization?