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

A. Insulin degludec B. Insulin lispro C. Insulin glargine 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 insulin regimen in patients with type 2 diabetes?

A. Initiate 10 units of glargine insulin at bedtime. B. Insulin administration should begin with QID dosing. C. Patients with T2D should not use the basal-bolus method. D. Start with a bolus insulin injected at bedtime.

4. A 60-year-old male patient with type 2 diabetes of 15 years duration provides his log book (below). Along with metformin 1000 mg twice daily, dulaglutide 1.5 mg once weekly, his current insulin regimen includes U-100 insulin glargine 60 units at bedtime and insulin aspart 20 units before breakfast, 15 units before lunch and 20 units before dinner. He has had no changes in his diet or exercise and confirms medication adherence. His current AIC is 8.9% and his before meal blood glucose goal range is 80-130 mg/dL. Based on the SMBG information below, what adjustment(s) if any do you recommend? Table for Question 4

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 T2D 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 male with type 1 diabetes of 8 years duration uses U-100 insulin glargine 20 units at bedtime and insulin lispro 7 units before breakfast and dinner and 5 units before lunch. He reports no changes in diet and he never misses his insulin doses. He exercises for 30 minutes on his lunch break during his work week. His current AIC is 6.9% and before meal blood glucose goal range is 80-130 mg/dL. What recommendation do you make based on the SMBG logbook results below? Table for Question 7

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, when should you counsel your patient to administer this insulin?

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

10. A 47-year-old Hispanic female with type 2 diabetes of 10 years duration uses NPH 40 units in the morning and 25 units at bedtime with insulin glulisine 10 units every morning before breakfast and before dinner. She reports no changes in diet or exercise. Her current AIC is 7.2% and her before meal blood glucose goal range is 80-130 mg/dL. What recommendation do you make based on the SMBG logbook results below? Table for Question 10

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