Which insulin regimen is inappropriate due to higher risk of hypoglycemia and no improvement in hyperglycemia management regardless of care setting?

• A. Insulin regimens containing only short- or rapid-acting insulin dosed according to current BG levels without concurrent basal or long-acting insulin
• B. Basal insulin regimens with long-acting insulin
• C. Premixed insulin regimens
• D. Insulin therapy with both basal and bolus components

Answer: (A)

A regimen that uses only short- or rapid-acting insulin dosed according to current blood glucose, with no basal or long-acting insulin, is inappropriate because it fails to provide background insulin coverage. Without a basal component, fasting and between-meal glucose aren’t controlled, so fasting hyperglycemia persists and overall glucose control doesn’t improve. Dosing reactively based on current glucose also increases the risk of hypoglycemia if meals are delayed, irregular, or mis-timed, and it doesn’t stabilize glucose across day and night. In contrast, regimens that include basal insulin (with or without bolus mealtime insulin) provide a steadier baseline and better address both fasting and postprandial glucose, reducing hypoglycemia risk in older adults.