Discuss NABP NAPLEX Exam Topic 8 Question 43

FT is a 23-year-old newly diagnosed type I diabetes admitted to the hospital due to diabetes ketoacidosis. 2 days after being on insulin drip, anion gap is closed. Physician would like your help in transitioning her to subcutaneous insulin. She suggests using insulin glargine once a day and Insulin lispro three time a day at ratio of 70:30. 70 % of long and 30 % of short acting insulin. FT received average of 70 units of insulin in 24hrs.

Which of the following would be the best insulin regimen?

A49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals

B25 units of Insulin Glargine subcutaneous daily and 15 units of Insulin Lispro subcutaneous three times a day with meals

C40 units of Insulin Glargine subcutaneous daily and 10 units of Insulin Lispro subcutaneous three times a day with meals

D46 units of Insulin Glargine subcutaneous daily and 8 units of Insulin Lispro subcutaneous three times a day with meals

E52 units of Insulin Glargine subcutaneous daily and 6 units of Insulin Lispro subcutaneous three times a day with meals

Suggested Answer: A

70% of 70 units = 49 units of Insulin Glargine daily 30% of 70 units = 21 units of Insulin Lispro daily. Dived in 3 doses would be 7 units three times a day. FT's Insulin regimen should be 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals

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13 comments · newest first

Antonio 11 months ago

Wait, why is the ratio 70:30? That’s unusual, right?

Owen 12 months ago

B has a good balance of long and short acting!

Elli 12 months ago

70% long-acting seems a bit high for a newbie.

Brice 12 months ago

I think option A sounds about right!

Galen 1 year ago

Insulin glargine is usually dosed once daily.

Adelina 1 year ago

I’m leaning towards option D because it seems to balance the long and short-acting insulin well, but I’m not entirely confident about the exact units needed.

Lorean 1 year ago

I practiced a similar question where we had to calculate the basal-bolus regimen. I feel like option C might be close, but I can't remember the exact calculations we did.

Tommy 1 year ago

I think the physician's suggestion of a 70:30 ratio is a bit off for this case. I recall that we usually start with a higher percentage of long-acting insulin for type I patients.

Aleisha 1 year ago

I remember we discussed the 50/50 rule for transitioning from IV to subcutaneous insulin, but I'm not sure how that applies here since the total daily dose is 70 units.

Erinn 1 year ago

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Reiko 1 year ago

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NABP NAPLEX Exam - Topic 8 Question 43 Discussion