Which insulin preparation is most appropriate for continuous subcutaneous insulin infusion (CSII) pump therapy, and what property makes it suitable?
- A Insulin lispro or aspart (rapid-acting analogues); monomeric at physiological pH, very rapid onset and predictable absorption ✓
- B NPH insulin; intermediate-acting, providing basal coverage
- C Insulin glargine; peakless extended release from subcutaneous depot
- D Regular insulin; stable hexameric form that dissolves slowly for sustained release
Correct answer: A. Insulin lispro or aspart (rapid-acting analogues); monomeric at physiological pH, very rapid onset and predictable absorption
Explanation
Rapid-acting insulin analogues (lispro, aspart, glulisine) are used in insulin pumps because they are monomeric at physiological concentration, giving rapid and predictable subcutaneous absorption with onset within 15 minutes. Pumps deliver rapid-acting insulin continuously (basal) and in boluses (mealtime), mimicking physiological secretion. NPH is not used in pumps due to unpredictable re-suspension. Glargine is not suitable for pump because its acid pH can precipitate in the catheter. Regular insulin is hexameric and too slow.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.