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1. Which of the following is a rapid-acting insulin product?

A. Insulin detemir (Levemir) B. Insulin aspart (Novolog) C. Insulin glargine (Basaglar, Lantus, Toujeo) D. Regular insulin

2. Basal insulin, when used correctly, is responsible for which of the following actions?

A. Suppression of hepatic glucose production B. Reduction of glucose concentrations after meals C. Increase in fatty acid production D. Increase in ketone production

3. Which of the following is TRUE when initiating a basal-bolus regimen in patients with type 2 diabetes mellitus (T2DM)?

A. Patients should monitor their glucose concentrations more frequently. B. Insulin administration should begin with four-times-a-day dosing. C. Patients with T2DM should not use the basal bolus method. D. Initiate 10 units of regular insulin at bedtime.

4. A 60 year old man with T2DM of 15 years' duration shows you his logbook (below). Along with metformin (Fortamet, Glucophage, Glucophage XR, Glumetza) 1000 mg twice daily, his current insulin regimen includes 60 units of 100 insulin glargine at bedtime and 20 units of insulin aspart before breakfast, 15 units before lunch, and 20 units before dinner. The patient has had no changes in his diet or exercise and confirms medication adherence. His current glycated hemoglobin (A1C) is 8.9% and his before- meal blood glucose (BG) goal range is 80 to 130 mg/dL. Based on the SMBG information below, what adjustment(s), if any, do you recommend?

A. Increase morning aspart to 25 units B. Increase both morning and evening insulin by 4 units each C. Increase bedtime glargine to 66 units D. Increase dinner aspart by 4 units

5. All of the following foods contain 15 grams of carbohydrate per serving, EXCEPT:

A. 1 cup low-fat milk B. 1 small apple C. 1 tbsp sugar D. 1 cup pasta

6. When instructing an obese patient with T2DM on administering insulin, all of the following are appropriate recommendations, EXCEPT:

A. Inspect insulin vials for contamination. B. Inject insulin at a 90-degree angle. C. Withdraw needle quickly and apply light pressure. D. Inject the insulin within 1 inch of the navel.

7. A 24-year-old manwith type 1 diabetes mellitus of 8 years' duration uses 20 units of U-100 insulin glargine at bedtime, with 7 units of insulin lispro (Humalog) before breakfast and dinner and 5 units before lunch. The patient reports no changes in diet, and he never misses his insulin doses. This individual exercises for 30 minutes on his lunch break every day of his workweek. His current A1C is 6.9%, and the before-meal BG goal range is 80 to 130 mg/dL. What recommendation do you make based on the SMBG logbook results below?

A. Increase evening lispro to 8 units B. Reduce lunchtime lispro to 4 units C. Increase evening glargine to 22 units D. Reduce morning lispro to 6 units

8. Which of the following patient-level barriers is the most common adverse event associated with insulin use?

A. Mild hypoglycemia B. Lipodystrophy C. Painful injections D. Weight loss

9. Based on the onset of action of insulin glulisine (Apidra), when should you counsel your patient to administer this insulin?

A. 0 to 5 minutes before a meal B. 10 to 15 minutes after a meal C. 30 to 60 minutes before a meal D. 30 to 60 minutes after a meal

10. A 47 year old Hispanic woman with T2DM of 10 years' duration uses 40 units of NPH in the morning and 25 units at bedtime, with 10 units of insulin glulisine every morning before breakfast and before dinner. She reports no changes in diet or exercise. The patient's current A1C is 7.2%, and her before-meal BG goal range is 80 to 130 mg/dL. What recommendation do you make based on the SMBG logbook results below?

A. Reduce morning NPH to 36 units B. Increase evening NPH to 44 units C. Reduce morning glulisine to 9 units D. Increase evening glulisine to 11 units