NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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When adding prandial insulin for T2DM, what is the starting dose before the largest meal?

4 units or 10% of basal dose SC QD
10 units or 20% of basal dose SC QD
5 units or 15% of basal dose SC QD
2 units or 5% of basal dose SC QD

The correct answer is: 4 units or 10% of basal dose SC QD

When adding prandial insulin for type 2 diabetes mellitus (T2DM), the starting dose before the largest meal is usually determined based on a percentage of the basal insulin dose. Starting with 4 units or 10% of the basal dose subcutaneously once daily (SC QD) is generally recommended to minimize the risk of hypoglycemia while still providing a therapeutic effect postprandially. This approach helps titrate the prandial insulin dose based on individual patient needs and response, ensuring that the insulin dose is gradually adjusted to achieve optimal glycemic control without causing severe hypoglycemia. Options B, C, and D suggest starting doses that are either too high or too low compared to the recommended guidelines for initiating prandial insulin therapy in T2DM. Starting with 4 units or 10% of the basal dose SC QD strikes a balance between initiating an effective insulin dose and reducing the risk of hypoglycemia in patients with T2DM.