A patient with type 1 diabetes develops recurrent hypoglycemia unawareness. His insulin regimen uses NPH insulin twice daily. Switching him to which insulin analog would most reduce nocturnal hypoglycemia risk?

• A Insulin lispro
• B Regular insulin
• C Insulin aspart
• D Insulin detemir or insulin glargine ✓

Explanation

NPH insulin has a pronounced peak at 6-10 hours that coincides with overnight hours when the patient is asleep and cannot respond to warning symptoms of hypoglycemia. Long-acting basal insulin analogs (glargine U-100/U-300, detemir) have a flat, peakless profile over 20-24 hours (glargine) or 12-20 hours (detemir), which dramatically reduces the nocturnal hypoglycemia risk compared to NPH. Insulin lispro, aspart, and regular insulin are rapid/short-acting and are used for prandial coverage; they do not address the basal overnight problem. Multiple clinical trials show basal analogs reduce nocturnal hypoglycemia by approximately 40-50% versus NPH.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.