skip to main content

Insulin-treated type 2 diabetes — SCE Endocrinology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateDiabetesInsulin-treated type 2 diabetesSCE Endocrinology

A 55-year-old woman with type 2 diabetes has fasting glucose 8–10 mmol/L but marked post-prandial readings after her evening meal. HbA1c is 72 mmol/mol on metformin, empagliflozin and basal insulin 34 units at night. Overnight glucose is stable. What is the most appropriate insulin adjustment?

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

Reveal the answer and explanation

Correct answer: B — Add rapid-acting insulin with the largest meal

Stable overnight glucose with post-prandial excursions indicates that further basal escalation is unlikely to solve the problem and may cause nocturnal hypoglycaemia. Adding mealtime rapid-acting insulin targets the dominant glycaemic pattern. The pearl is to use glucose profiles rather than HbA1c alone when intensifying insulin.

Reference: NICE NG28; BNF