Pharmacy PEBC Practice Exam

BG, a 45 year old male with type 1 diabetes mellitus, is currently using a premixed 30/70 combination of regular and intermediate-acting insulin subcut bid (before breakfast and supper). The following blood glucose values are observed: 5.8 mmol/L at 2200 h, 3.6 mmol/L at 0300 h, 10.2 mmol/L at 0800 h (2 hours after breakfast). Which of the following is the most appropriate initial adjustment for BG’s insulin regimen?

1. Decrease the suppertime insulin dose.

2. Increase the suppertime insulin dose.

3. Decrease the breakfast time insulin dose.

4. Increase the breakfast time insulin dose.

The correct answer is: Decrease the suppertime insulin dose.

Premixed 30/70 insulin is a combination of regular and intermediate-acting insulin, which is typically taken before breakfast and dinner. The morning blood glucose level of 10.2 mmol/L is higher than the target range (4.0-7.0 mmol/L) and indicates that the breakfast time insulin dose may need to be adjusted. However, the evening blood glucose level of 5.8 mmol/L and the low level of 3.6 mmol/L at 0300 h suggest that BG may be experiencing hypoglycemia during the night. Therefore, the most appropriate initial adjustment would be to decrease the suppertime insulin dose, as this will help prevent hypoglycemia while also potentially lowering the post-breakfast blood glucose level. Increasing the suppertime dose (option B) may lead to further nocturnal hypoglycemia. Decre