Endocrine Pharmacology USMLE Step 1 Practice Question

A 46-year-old woman with a 22-year history of type 1 diabetes mellitus presents to her endocrinologist for a routine follow-up, reporting episodes of nocturnal diaphoresis, palpitations, and morning headaches occurring three to four times per week over the past two months. Her current regimen includes a basal insulin with a pronounced overnight peak, which her endocrinologist suspects is responsible for her recurrent hypoglycemic episodes. Her fasting blood glucose this morning was 58 mg/dL, and her HbA1c is 6.2%, suggesting frequent unrecognized hypoglycemia. Vital signs are within normal limits, and her BMI is 23 kg/m². To minimize nocturnal hypoglycemia while maintaining adequate glycemic control, her endocrinologist switches her to a long-acting basal insulin analog that provides relatively steady 24-hour coverage with little to no pronounced peak. Which of the following was most likely prescribed?