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Basal insulin switching — GPhC CRA MCQ

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ModerateEndocrine TherapeuticsBasal insulin switchingGPhC CRA

A 35-year-old man with type 1 diabetes is switching from twice-daily insulin isophane to once-daily insulin glargine. He asks the pharmacist when he should start the insulin glargine. What is the most appropriate advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — The initial insulin glargine dose should be approximately 80% of the total daily isophane dose, taken at the same time each day, with dose titration based on fasting glucose

When switching from twice-daily NPH (isophane) to once-daily insulin glargine, the usual recommendation is to start at approximately 80% of the total daily NPH dose to reduce the risk of hypoglycaemia during the transition. The dose is then titrated based on fasting blood glucose. Insulin glargine can be given at any time of day as long as it is at the same time each day. Concurrent use of both basal insulins is not recommended.

Reference: BNF Insulin Glargine; NICE NG17 Type 1 Diabetes