A prescription is received for 'NovoRapid® (insulin aspart) 10 units subcutaneously three times daily with meals'. The patient's chart indicates poor glycemic control (HbA1c 9.5%) despite maximum oral therapy (metformin 1000 mg BID, gliclazide MR 60 mg daily). Which is the most appropriate action for the pharmacist?

Question: A prescription is received for 'NovoRapid® (insulin aspart) 10 units subcutaneously three times daily with meals'. The patient's chart indicates poor glycemic control (HbA1c 9.5%) despite maximum oral therapy (metformin 1000 mg BID, gliclazide MR 60 mg daily). Which is the most appropriate action for the pharmacist?

Answer options:

• Dispense as written, and counsel the patient on proper insulin injection technique and storage. ✅ Contact the prescriber to clarify if a basal insulin component should also be initiated.
• Advise the patient to skip the next meal's insulin dose if their blood sugar is less than 6 mmol/L.
• Recommend reducing the gliclazide MR dose to prevent hypoglycemia when starting insulin.

Correct answer: Contact the prescriber to clarify if a basal insulin component should also be initiated.

Explanation: While bolus insulin is important for postprandial glucose control, patients with an HbA1c of 9.5% typically require a basal insulin component as well, especially if they are already on maximum doses of oral agents. The pharmacist should clarify the complete insulin regimen with the prescriber.