Which type of insulin should be used when initiating enteral nutrition in a hospitalized diabetic patient?

• A. Regular insulin
• B. Premixed NPH/Regular insulin
• C. NPH insulin
• D. Insulin glargine

Answer: (A)

Starting enteral nutrition in a hospitalized patient often causes a predictable rise in glucose from the carbohydrate in the feeds, so you want an insulin that can rapidly respond to those changes. Regular insulin is the best fit because it has a quick onset (about 30–60 minutes) and a relatively short, titratable duration, which makes it easy to align with fed carbohydrates and to adjust based on frequent glucose checks. This allows tight, postprandial and overall glycemic control as the feeding plan is modified.

Other insulins don’t match feeds as well. NPH is longer-acting with a peak that can misalign with continuous feeds, risking hypoglycemia or hyperglycemia. Premixed regimens fix a ratio that’s hard to adjust to changing feed rates. Glargine provides basal coverage but doesn’t reliably address feed-related glucose excursions, especially during initiation when feeding patterns may vary.

So regular insulin offers the safest, most controllable approach when initiating enteral nutrition in the inpatient setting.