Insulin Pharmacology Quiz

A 55-year-old male patient with diabetes has an allergy to recombinant human insulin. His physician is considering a request for the FDA to allow the importation of a certain type of insulin. What type of insulin is likely being considered?

A new form of insulin is being developed with modifications to the insulin molecule structure to alter its pharmacokinetic properties. In what region of the insulin molecule are these modifications generally made?

An in vitro study on insulin analogs has shown that insulin glargine has a higher mitogenic potency and IGF-1 receptor affinity compared to human insulin. However, its metabolite M1 showed different results. How does the IGF-1 receptor binding affinity of the M1 metabolite compare to human insulin?

A 64-year-old female patient with diabetes reports having reactions to her insulin therapy, which includes the development of lumps under the skin at injection sites. She has been administering insulin into the same subcutaneous site. What condition is the patient likely experiencing?

A 58-year-old male patient with severe insulin resistance is on a high daily dose of insulin (>200 units per day). What type of insulin concentration would be most suitable for this patient in the United States?

A 35-year-old female patient from outside the United States who is newly diagnosed with diabetes needs to start insulin therapy. She has been prescribed a U-40 insulin. What is the most important advice she should remember when she is traveling?

A 46-year-old patient is taking insulin aspart for diabetes. They recently started intravenous (IV) administration after a hospital admission. How would the action of insulin aspart when administered IV compare to regular insulin?

A 58-year-old man with diabetes is taking long-acting insulin glargine. He is unsure about the method of administration and mixing with other insulins. What is the most appropriate advice?

A 38-year-old woman with diabetes has been using insulin aspart and varies her injection sites between her abdomen and her thigh. Based on pharmacokinetic profiles, which of the following is the most appropriate advice to give her?

A 55-year-old male patient with diabetes mellitus is on regular insulin injections. After his injections, he likes to relax in a hot bath. How might this habit affect his insulin absorption?

A 68-year-old man with diabetes and chronic kidney disease has noticed that he needs less insulin than before. How could you explain this change?

A 40-year-old woman with diabetes, who is on intermediate-acting insulin, notices that her blood sugar levels are more unpredictable when she forgets to shake her insulin bottle before use. What is likely causing this issue?

A 45-year-old male with type 1 diabetes is using regular insulin. He finds it inconvenient to follow the 30-minute pre-meal schedule for insulin injection. Which of the following could be a potential solution for his situation?

A 38-year-old female with type 1 diabetes is on insulin pump therapy. She experiences frequent infusion site reactions. She is currently on insulin aspart. Which of the following would be the most appropriate management?

A 5-year-old child has recently been diagnosed with type 1 diabetes. His parents are finding it difficult to predict the amount of carbohydrates he will consume at a meal. Which type of insulin would be most suitable in this scenario?

A 52-year-old male with a history of type 2 diabetes is considering switching from subcutaneously administered rapid-acting insulin to an inhaled insulin formulation. He also has COPD. What is the best advice regarding his plan?

A 38-year-old woman with type 1 diabetes is being switched from NPH insulin to another form of insulin to reduce her risk of nocturnal hypoglycemia. What insulin would be the most suitable choice?

A 56-year-old male with type 1 diabetes and a severe human insulin allergy needs to switch his insulin type. Which type of insulin has been shown to be less immunogenic and therefore a suitable choice for him?

A 65-year-old female patient with type 2 diabetes reports waking up in the middle of the night feeling shaky and sweaty. She currently uses NPH insulin. What would be the most suitable insulin to switch her to, considering her symptoms?

A 45-year-old male with type 1 diabetes on insulin glargine is experiencing hypoglycemic episodes during the day. Which ultra-long-acting insulin would be a suitable alternative for him?

A 55-year-old female with type 2 diabetes and a history of cardiovascular disease is currently using insulin glargine. What can be said about her risk of major adverse cardiovascular events if she were to switch to insulin degludec?

A 50-year-old patient with type 2 diabetes has been frequently missing their insulin doses and is struggling with glycemic control. They are currently on a basal/bolus insulin regimen. What could be a beneficial adjustment to their insulin regimen?

A patient with type 1 diabetes is prescribed insulin glargine. They report that they often forget to refrigerate their unopened insulin, which is impacting their glycemic control. What advice can be given to this patient about insulin storage?

A 60-year-old male with type 2 diabetes is currently using insulin glargine. However, due to insurance coverage issues, the patient's pharmacy wants to switch his insulin to a different brand. Which insulin could be a suitable substitute, assuming it would not need prescriber notification for the switch?

A 72-year-old female with type 2 diabetes and coronary artery disease is on insulin therapy. She frequently experiences hypoglycemia. Her HbA1c is currently at 6.2%. What could be a beneficial adjustment to her glycemic targets to reduce hypoglycemia?

A 30-year-old male with type 1 diabetes is under insulin therapy. He has been experiencing hypoglycemia frequently. Besides adjusting his insulin dosage and diet, which of the following interventions might help reduce his hypoglycemia episodes?

A 45-year-old female with type 2 diabetes is currently under insulin therapy. She has noticed significant weight gain since starting insulin therapy and wishes to manage it. Her current insulin regimen includes glargine insulin. What could be an alternative insulin to consider to manage her weight gain?

A 63-year-old male patient with type 2 diabetes is currently managed with intensive insulin therapy. He has a history of renal insufficiency and recurrent episodes of hypoglycemia. His HbA1c level is 7.2%. The patient is worried about his frequent hypoglycemic episodes. As a doctor, which of the following adjustments would you most likely recommend?

A 55-year-old woman with type 1 diabetes is currently on an insulin regimen that includes NPH insulin. She has been experiencing weight gain, which is causing her distress. What might be an alternative insulin for this patient to help manage her weight gain?

A 42-year-old man with type 2 diabetes has been treated with long-acting insulin alone. Given his history of hypertension and hyperlipidemia, you are considering adding short-acting insulin to his regimen. What is a possible outcome of this combined therapy based on previous retrospective studies?

A 58-year-old man with a history of type 2 diabetes is currently managed with metformin, a GLP-1 receptor agonist, and an SGLT2 inhibitor. However, his HbA1C remains above goal after 3 months of treatment. What would be the most appropriate next step in management?

A 42-year-old woman with type 2 diabetes has her fasting glucose levels well controlled with basal insulin, but her glucose levels rise significantly higher later in the day with a persistently elevated HbA1C. What could be the next step in her management?

A 30-year-old man with type 1 diabetes is about to start insulin therapy. What is the preferred initial insulin regimen for this patient?

A 56-year-old man with type 2 diabetes is not reaching his glycemic goals despite a daily regimen of metformin, an SGLT2 inhibitor, and basal insulin. His current HbA1c is 8.2%. What could be the next step in his treatment plan?

A 70-year-old woman with type 2 diabetes is suffering from nocturnal hypoglycemia. She is on a twice-daily insulin regimen, taking two-thirds of the insulin dose in the morning before breakfast and one-third before dinner. What could be done to reduce her risk of nocturnal hypoglycemia?

A 45-year-old man with type 2 diabetes, whose blood glucose levels are not well controlled with non-insulin anti-hyperglycemic agents, is started on a daily basal insulin regimen. The initial dose is calculated by multiplying 0.2 by the patient’s weight in kilograms. He weighs 80 kg. What is the patient's initial daily dose of basal insulin?

A 35-year-old woman with type 1 diabetes is transitioning to an insulin pump therapy regimen. She's been trained in carbohydrate counting and adjustments in insulin bolus dose based on meal content and physical activity. How is her basal insulin requirement likely to fluctuate throughout the day in a typical insulin pump therapy regimen?

A 50-year-old man with type 2 diabetes, who is markedly insulin-deficient, is using multiple daily injections of regular insulin before meals and insulin glargine at bedtime. His glucose control remains suboptimal despite strict adherence to the regimen. What could be a possible next step in his treatment plan?

A 28-year-old man with type 1 diabetes is on insulin pump therapy. After lunch, he checks his blood glucose level and finds it elevated. He enters this information into his insulin pump. How does the insulin pump help him determine the corrective supplemental insulin dose?

A 42-year-old man with type 1 diabetes has been using an insulin pump with a continuous glucose monitoring system. He often experiences hypoglycemia. Which function of insulin pumps might help prevent his glucose levels from declining further?

A 55-year-old woman with type 1 diabetes is starting to use the Omnipod 5 hybrid closed loop system. Which of the following adjustments can she make when in the automated insulin delivery mode?

A 48-year-old man with type 1 diabetes is experiencing frequent hypoglycemia. His current regimen involves the use of intermediate-acting insulin. According to best practices, how should his insulin doses be adjusted?

A 58-year-old man with type 2 diabetes is currently using a basal insulin regimen with glargine every evening at bedtime. His fasting glucose readings are consistently above 150 mg/dL. How would you adjust his insulin regimen?

A 45-year-old woman with type 2 diabetes is using a total daily insulin dose of 60 units. She wants to correct her high glucose levels using supplemental insulin. Her pre-meal glucose level is 280 mg/dL. How many units of supplemental insulin would be needed to decrease her glucose level by 180 mg/dL?

A 40-year-old man with type 2 diabetes is using a total daily dose of 50 units of insulin. He wants to calculate his insulin to carbohydrate ratio (ICR) for meal planning. What would his ICR be?

A 42-year-old woman with type 1 diabetes who regularly exercises in the mornings finds her blood sugar levels to be frequently low after her workouts. What could be a suitable adjustment for her to prevent exercise-induced hypoglycemia?

A 60-year-old man with type 2 diabetes is instructed to self-monitor his blood glucose levels. According to the ADA, when should he check his blood glucose if he is not on multiple daily injections of insulin?

A 55-year-old woman with type 1 diabetes is ill and unable to eat. She thinks she should skip her insulin because she isn't eating. What should she do?