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

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

Answer: (A)

When starting enteral nutrition in a hospitalized diabetic patient, you want an insulin that can closely match the carbohydrate load from feeds and be adjusted quickly as feeding changes. Regular insulin is short-acting with a predictable onset and duration, and it can be given subcutaneously or used in an IV infusion when tight control is needed. This makes it ideal for covering meals and adjusting doses as the rate or amount of nutrition changes.

Longer-acting insulins or those with fixed ratios don’t provide the rapid, flexible control needed during initiation of enteral feeds. NPH has a pronounced peak and a variable duration, increasing the risk of hypoglycemia if feeds are interrupted. Glargine is basal and has no significant peak, so it doesn’t adequately cover postprandial glucose from feeds. Premixed regimens reduce dosing flexibility and are harder to tailor to changing feeding rates. Regular insulin therefore offers the appropriate balance of rapid action and titratability for initiating enteral nutrition.