Common Registration Assessment · Topic deep-dive
GPhC Diabetes and Insulin Questions
The June 2025 Board of Assessors feedback names insulin specifically: “Trainee pharmacists should know the different insulin preparations and their time action profiles. They should be able to interpret trends in blood glucose levels and adjust insulin doses and timing if there are issues such as hypo- or hyper-glycaemia.” This is a recurring weak area.
What the GPhC actually tests on this topic
- Insulin preparations: rapid-acting (lispro, aspart, glulisine), short-acting (soluble), intermediate-acting (isophane), long-acting (glargine, detemir, degludec), biphasic mixed insulins
- Time-action profiles: onset, peak, duration for each insulin class
- Blood glucose interpretation: what a pattern of morning highs vs evening highs tells you about which insulin to adjust
- Dose adjustment: titration steps for hypo- and hyper-glycaemia, recognising the Somogyi effect vs dawn phenomenon
- Type 2 diabetes pharmacotherapy: metformin, SGLT2 inhibitors, GLP-1 agonists, the NICE pathway for intensification
- Sick day rules and DKA recognition
Common pitfalls — from the Board of Assessors’ feedback
Mixing up time-action profiles
Knowing that aspart is rapid-acting and degludec is long-acting is not enough — you need to know the onset, peak, and duration for each. Exam questions hand you a blood-glucose pattern and ask which insulin to adjust at which time of day.
Adjusting the wrong dose for a high or low reading
A 7am high suggests overnight insulin (long-acting or evening intermediate) needs adjustment, not the morning rapid-acting. A pre-lunch low suggests the breakfast rapid-acting is too high. Pattern recognition matters more than memorising a single titration rule.
NICE pathway for type 2 diabetes intensification
NG28 specifies the order of intensification (metformin → SGLT2 inhibitor / DPP-4 inhibitor / GLP-1 agonist depending on indication and cardiovascular risk → insulin). The default-add-insulin answer is often wrong if a non-insulin agent fits the patient profile better.
Sample practice questions
CRA-style practice questions, not real exam questions. The Board of Assessors does not endorse third-party question banks.
A clinical pharmacist is reviewing Mr O'Brien, a 57-year-old male with co-existing AF on warfarin (target INR 2.0-3.0), frequent INR fluctuations, and CKD stage 3. Current medications include metformin 1 g BD, gliclazide 80 mg BD, ramipril 5 mg OD, and atorvastatin 40 mg ON. HbA1c 72 mmol/mol. Fasting glucose 12.4. eGFR 45. ACR 8 mg/mmol. In the context of this clinical picture, a patient diagnosed with type 2 diabetes is interested in lifestyle interventions to manage their condition. Which of the following recommendations is NOT appropriate?
- A. Engage in 150 minutes of moderate exercise weekly
- B. Follow a low-carbohydrate diet
- C. Limit alcohol intake to one drink per day
- D. Take a daily multivitamin
- E. Monitor blood glucose levels regularly
Show worked answer
Correct answer: D
Which type of dosage form is suitable for a drug with high first-pass metabolism to achieve systemic effects?
- A. Oral tablet
- B. Sublingual tablet
- C. Topical gel
- D. Rectal suppository
- E. Intramuscular injection
Show worked answer
Correct answer: B
Diabetes and insulin — frequently asked
How does the GPhC test insulin in the exam?
Through scenario questions that give you a blood glucose pattern and ask which insulin to adjust, by how much, and at what time. The Board of Assessors’ June 2025 feedback explicitly named this pattern as a weak area. Memorising insulin classes is necessary but not sufficient.
What is the difference between the Somogyi effect and the dawn phenomenon?
The dawn phenomenon is morning hyperglycaemia caused by overnight rise in counter-regulatory hormones — the fix is usually to increase or shift the long-acting insulin. The Somogyi effect is morning hyperglycaemia caused by a nocturnal hypo with rebound — the fix is usually to decrease the long-acting insulin. They look the same on a single reading; you need overnight monitoring to distinguish them.
Which type 2 diabetes guideline does the CRA test against?
NICE NG28. The pathway emphasises cardiovascular and renal risk assessment when choosing intensification beyond metformin — SGLT2 inhibitors have specific indications for heart failure and chronic kidney disease.
Practise diabetes and insulin questions in context
Across the full bank of GPhC exam questions — every format, with worked answers grounded in the Board of Assessors’ published feedback.