Insulin MCQs With Answer

Insulin MCQs With Answer

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Insulin MCQs With Answer is a focused resource for B. Pharm students covering insulin pharmacology, mechanisms, types, pharmacokinetics, clinical uses, storage, administration devices, adverse effects and biosimilars. This concise set explores molecular action (insulin receptor signaling and GLUT4 translocation), differences among rapid-, short-, intermediate- and long-acting analogs, dosing calculations, hypoglycaemia management, and special situations such as pregnancy, renal or hepatic impairment. Emphasis is placed on practical pharmacy topics: mixing insulins, pen and pump use, stability and excipient roles, immunogenicity and monitoring (C‑peptide, glucose). Designed to deepen understanding and exam preparedness. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. What is the primary mechanism by which insulin lowers blood glucose?

  • Increase GLUT4 translocation to the cell membrane
  • Stimulate hepatic gluconeogenesis
  • Inhibit glycogen synthesis
  • Block insulin receptor tyrosine kinase

Correct Answer: Increase GLUT4 translocation to the cell membrane

Q2. Which structural feature differentiates insulin lispro from human insulin?

  • Substitution of proline and lysine at B28 and B29
  • Deletion of the B-chain
  • Additional carbohydrate side chain
  • Formation of a covalent dimer

Correct Answer: Substitution of proline and lysine at B28 and B29

Q3. Which insulin preparation has the longest duration of action?

  • Insulin glargine U‑100
  • Regular human insulin
  • Insulin lispro
  • Neutral protamine Hagedorn (NPH) insulin

Correct Answer: Insulin glargine U‑100

Q4. Which statement about NPH insulin is correct?

  • It is an intermediate-acting insulin formulated with protamine
  • It is a rapid-acting insulin analog
  • It should never be mixed with regular insulin
  • It has no peak action time

Correct Answer: It is an intermediate-acting insulin formulated with protamine

Q5. Which of the following is the best immediate treatment for severe hypoglycaemia with unconscious patient?

  • IV 50% dextrose bolus
  • Oral glucose tablet
  • Subcutaneous insulin
  • Oral sucrose solution

Correct Answer: IV 50% dextrose bolus

Q6. Which analytic measure distinguishes endogenous from exogenous insulin administration?

  • C‑peptide level
  • Serum potassium
  • Urine glucose
  • Fasting lipid panel

Correct Answer: C‑peptide level

Q7. Which preservative commonly found in multi-dose insulin vials acts as an antimicrobial agent?

  • Metacresol (m‑cresol)
  • Sodium chloride
  • Glycerol
  • Insulin hexamer

Correct Answer: Metacresol (m‑cresol)

Q8. Which insulin analog is preferred for rapid prandial coverage?

  • Insulin aspart
  • Insulin glargine
  • NPH insulin
  • Insulin detemir

Correct Answer: Insulin aspart

Q9. How does insulin promote lipid synthesis in adipose tissue?

  • Activates lipoprotein lipase and inhibits hormone‑sensitive lipase
  • Stimulates hormone‑sensitive lipase activity
  • Blocks acetyl‑CoA carboxylase
  • Inhibits fatty acid synthase

Correct Answer: Activates lipoprotein lipase and inhibits hormone‑sensitive lipase

Q10. Which statement about insulin storage is correct?

  • Unopened vials should be refrigerated between 2–8°C
  • All opened insulin must be frozen
  • Insulin stability is unaffected by temperature
  • Opened vials must be discarded after 24 hours

Correct Answer: Unopened vials should be refrigerated between 2–8°C

Q11. Which receptor activity is intrinsic to the insulin receptor?

  • Tyrosine kinase activity
  • Guanylate cyclase activity
  • G‑protein coupled receptor activity
  • Serine protease activity

Correct Answer: Tyrosine kinase activity

Q12. A patient requires switching from twice‑daily NPH to a basal analog. What is a reasonable initial approach?

  • Total daily NPH basal dose given as once‑daily glargine with monitoring
  • Stop all insulin and start oral metformin immediately
  • Replace NPH with equivalent dose of insulin lispro
  • Double the NPH dose to cover basal needs

Correct Answer: Total daily NPH basal dose given as once‑daily glargine with monitoring

Q13. Which factor increases risk of insulin-induced hypoglycaemia?

  • Renal impairment reducing insulin clearance
  • Concurrent corticosteroid therapy
  • Hyperthyroidism increasing insulin requirements
  • High carbohydrate meal after insulin

Correct Answer: Renal impairment reducing insulin clearance

Q14. How does insulin detemir achieve prolonged action?

  • Acylation enabling reversible albumin binding
  • Increased glycosylation for renal excretion
  • Binding to protamine to form crystals
  • Rapid monomer formation

Correct Answer: Acylation enabling reversible albumin binding

Q15. Which dosing rule is commonly used for initial basal insulin in type 2 diabetes?

  • 0.1–0.2 units/kg/day
  • 2–3 units/kg/day
  • 10 units/kg/day
  • 0.8–1.2 units/kg/day

Correct Answer: 0.1–0.2 units/kg/day

Q16. Which laboratory pattern is expected in type 1 diabetes at diagnosis?

  • Low insulin with high glucose and low C‑peptide
  • High insulin with high C‑peptide
  • Normal insulin and high C‑peptide
  • Low glucose and high C‑peptide

Correct Answer: Low insulin with high glucose and low C‑peptide

Q17. Mixing insulins: which instruction is correct when combining clear and cloudy insulins in one syringe?

  • Draw up clear (rapid/short‑acting) insulin first, then cloudy (NPH)
  • Always draw cloudy insulin first
  • Mix by shaking vial vigorously to combine
  • Never mix any insulins in one syringe

Correct Answer: Draw up clear (rapid/short‑acting) insulin first, then cloudy (NPH)

Q18. Which adverse effect is most characteristic of insulin therapy besides hypoglycaemia?

  • Weight gain due to anabolic effects
  • Renal tubular necrosis
  • Ototoxicity
  • Hyperuricaemia

Correct Answer: Weight gain due to anabolic effects

Q19. In insulin pharmacokinetics, what does “onset of action” refer to?

  • Time from administration to first clinically significant glucose lowering
  • Time until drug is completely eliminated
  • Time to maximum concentration in the vial
  • Duration of hyperglycaemic effect

Correct Answer: Time from administration to first clinically significant glucose lowering

Q20. Which insulin delivery device reduces dosing errors and improves adherence in many patients?

  • Prefilled insulin pens with dose dial
  • Glass syringe requiring manual drawing from vial
  • Oral insulin tablets
  • Transdermal insulin patches widely available

Correct Answer: Prefilled insulin pens with dose dial

Q21. Which molecule is the immediate precursor cleaved to form insulin and C‑peptide?

  • Proinsulin
  • Preproglucagon
  • Proglucagon
  • Somatostatin

Correct Answer: Proinsulin

Q22. In what clinical situation is intravenous insulin infusion preferred?

  • Diabetic ketoacidosis requiring rapid titration
  • Routine outpatient basal dosing
  • Administering long‑acting insulin at bedtime
  • Initial therapy for mild hyperglycaemia

Correct Answer: Diabetic ketoacidosis requiring rapid titration

Q23. Which insulin analog has a more predictable peakless basal profile suitable for once‑daily dosing?

  • Insulin glargine
  • Regular human insulin
  • Insulin lispro
  • NPH insulin

Correct Answer: Insulin glargine

Q24. Which effect does beta‑adrenergic blockade have on insulin‑induced hypoglycaemia recognition?

  • Masks adrenergic symptoms (tremor, palpitations) making recognition harder
  • Enhances adrenergic warning signs
  • Prevents neuroglycopenic symptoms entirely
  • Increases insulin clearance reducing hypoglycaemia risk

Correct Answer: Masks adrenergic symptoms (tremor, palpitations) making recognition harder

Q25. What is a key pharmacovigilance concern with insulin biosimilars?

  • Immunogenicity and potential antibody formation
  • Guaranteed identical pharmacokinetics to innovator without monitoring
  • Universal interchangeability without any clinical data
  • No requirement for cold chain during transport

Correct Answer: Immunogenicity and potential antibody formation

Q26. Which insulin parameter is most affected by subcutaneous injection site rotation?

  • Absorption variability due to lipohypertrophy
  • Chemical structure of insulin molecule
  • Insulin receptor affinity
  • Intrinsic potency per unit

Correct Answer: Absorption variability due to lipohypertrophy

Q27. Which hormone counteracts insulin’s hypoglycaemic action by increasing hepatic glucose output?

  • Glucagon
  • Amylin
  • Insulin‑like growth factor 1
  • Adiponectin

Correct Answer: Glucagon

Q28. Which change occurs in the insulin receptor after insulin binding?

  • Autophosphorylation of β subunits leading to downstream signalling
  • Receptor internalization without phosphorylation
  • Immediate receptor degradation
  • Conversion to a G‑protein coupled receptor

Correct Answer: Autophosphorylation of β subunits leading to downstream signalling

Q29. For a patient on multiple daily injections, what is the role of rapid‑acting insulin?

  • Control postprandial glucose excursions
  • Provide basal insulin overnight
  • Prevent infusion set occlusion
  • Reduce insulin antibody formation

Correct Answer: Control postprandial glucose excursions

Q30. When counseling a patient about insulin pens, which instruction is essential?

  • Prime the pen with a small test dose before each injection
  • Always store in freezer after first use
  • Never check for air bubbles before injection
  • Reuse disposable pen cartridges indefinitely

Correct Answer: Prime the pen with a small test dose before each injection

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