A 58-year-old man with a 12-year history of type 2 diabetes mellitus presents to his primary care physician reporting recurrent episodes of diaphoresis, tremulousness, and confusion occurring between 4:00 and 6:00 PM over the past two weeks. He takes a single subcutaneous insulin injection each morning at 7:00 AM and consistently eats lunch at noon. His fingerstick glucose during one episode measured 48 mg/dL, and symptoms resolved promptly after ingesting orange juice. His BMI is 31 kg/m², blood pressure is 128/82 mmHg, and his most recent HbA1c is 7.1%. His current insulin formulation appears cloudy in the vial, has an intermediate duration of action, and produces a pronounced pharmacodynamic peak approximately 6 to 8 hours after administration. Which of the following drugs is most likely responsible?
- A)Insulin lispro
- B)Regular insulin
- C)NPH insulinGABARITO
- D)Insulin degludec
- E)Insulin glargine
Explicação
NPH is an intermediate acting insulin with a distinct peak, so symptomatic hypoglycemia can occur several hours after injection. The late afternoon timing after a morning dose fits the expected pharmacokinetic profile of NPH better than the flatter basal insul... Ver explicação completa e trilha adaptativa →