After enteral nutrition administration is stable in the diabetic patient, what insulin regimen is recommended?

• A. A basal/bolus insulin regimen
• B. Regular insulin only
• C. NPH insulin alone
• D. Insulin glargine alone

Answer: (A)

The main concept is matching insulin therapy to the pattern of enteral feeding. When enteral nutrition is stable, you want insulin that provides both a steady background and coverage for the carbohydrate load from the feeds. A basal/bolus regimen does this: a long-acting basal insulin provides constant background levels to control fasting glucose, while rapid- or short-acting insulin given with each feeding handles the post-feed glucose rise. This approach closely mimics normal physiology and offers flexibility if the feeding rate changes.

Using regular insulin alone lacks reliable basal coverage and timing with continuous or scheduled feeds, making glycemic control harder and increasing excursion risk. NPH insulin alone has variability and a prominent peak, which can lead to hypoglycemia or hyperglycemia with feeding. Insulin glargine alone provides basal coverage but does not address postprandial spikes from the enteral nutrition. Therefore, combining basal and bolus insulin best aligns with stable enteral nutrition in a diabetic patient.