Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is an appropriate substitute for a patient who must stop taking half of their insulin due to insurance limitations?

1. NPH/regular (Novolin 70/30)

2. Levemir

3. NPH (Novolin N)

4. Lispro (Humalog)

The correct answer is: Lispro (Humalog)

In situations where a patient has to reduce their insulin dosage due to insurance limitations, it's essential to consider the pharmacokinetics and the action profiles of different insulin types. The appropriate substitute in this scenario needs to offer flexibility in adjusting dosages while providing effective blood glucose control. Using rapid-acting insulin, such as Lispro (Humalog), allows for more precise dosing relative to carbohydrate intake and blood glucose levels. Rapid-acting insulins have a quick onset and shorter duration of action, which means patients can better tailor their insulin doses to their meals and activity levels. This adaptability is particularly beneficial for those needing to adjust their total insulin administration while maintaining optimal control. In contrast, the other options like NPH/regular mixtures or long-acting insulins do not offer the same level of flexibility. NPH, for example, is an intermediate-acting insulin that has a longer duration and less efficient meal-specific adjustment capability. Such profiles may lead to gaps in coverage or an increased risk of hypoglycemia if dosing is not managed precisely. In summary, choosing Lispro (Humalog) provides the patient with greater control and adaptability in managing blood glucose levels despite the limitation in total insulin quantity. This approach can help maintain glycemic targets while