What is the recommended approach for converting long-acting insulin to NPH insulin?

The recommended approach for converting long-acting insulin to NPH insulin is to use a unit-for-unit conversion and administer NPH twice daily (B). This method ensures that the patient's overall insulin requirements are adequately met while accounting for the differences in the pharmacokinetic profiles of long-acting insulin and NPH.

Long-acting insulin typically has a flatter and more prolonged action compared to NPH, which has a peak effect and a shorter duration of action. Therefore, when transitioning a patient from long-acting insulin to NPH, using a direct conversion (unit-for-unit) makes sense to maintain similar glycemic control. The twice-daily administration of NPH helps to cover both basal and meal-related insulin needs more effectively, aligning the insulin action pattern with the patient's lifestyle and dietary intake.

Other options suggest drastic reductions or specific dosing schedules that may not adequately cover the patient's insulin needs, leading to potential hyperglycemia or difficulty managing diabetes effectively. Thus, the most balanced and effective strategy for this conversion is to use a unit-for-unit approach with NPH administered twice daily, ensuring comprehensive coverage for the patient's blood sugar management.