A 55-year-old man arrives at the emergency room complaining of progressive weakness and lethargy. The patient claims that he has been excessively thirsty and waking up several times at night to urinate for the past three months. Despite no change in appetite, he has also lost 5 kg (11 lb) during this time. The patient hasn't seen a doctor in a long time. His mother and father have a family history of type 2 diabetes mellitus. The blood pressure is 108/60 mm Hg, and the pulse rate is 98 beats per minute. The BMI is 38 kg/m2². A physical examination reveals dry mucous membranes and a lack of skin turgor. A blood glucose concentration of 600 mg/dL is revealed by laboratory testing. Serum beta-hydroxybutyrate levels are normal, and hemoglobin A1c is 14%. The next day, his symptoms significantly improve, and the blood glucose levels normalize. In preparation for discharge, his insulin infusion is changed to a subcutaneous regimen that closely mimics the physiologic pattern of insulin release. This patient's insulin therapy was most likely transitioned to which of the following regimens?

Question

Quizplus · Accepted Answer

Eductional Objective: A combination of long-acting and rapid-acting insulin analogs can approximate physiological insulin secretion. Long-acting preparations (for example, glargine) are slowly released from the injection site throughout the day and mimic basal insulin secretion. To control postprandial glucose elevations, boluses of a rapid-acting insulin (e.g., lispro) with rapid absorption are given with meals.

A 55-Year-Old Man Arrives at the Emergency Room Complaining of Progressive