Review Note

Last Update: 02/05/2025 08:20 AM

Current Deck: BPT QC

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Front

A 35 year old woman with type 1 diabetes since age 14 is reviewed. She reports three episodes of hypoglycemia with levels <3.0 mmol/L during the night in the last month. There have also been a number of hypoglycemic episodes in the late morning. Recent results show:

- Weight 55kg

- Fasting plasma glucose 12.3 mmol/L (4 - 6)

- HbA1c 6.9% (<6)

- Urine microalbumin: creatinine ratio 0.1 (<3.5)

Current insulin regimen

- Neutral protamine Hagedorn (NPH) insulin 14 units breakfast, 12 units before bed

- Insulin aspart 4 - 6 units before breakfast and lunch, and 8-10 units before dinner

Which one of the following modifications to her insulin regimen would be most effective in optimizing her glycemic control?

A. Omit evening NPH insulin

B. Change time of evening NPH insulin to before evening meal

C. Reduction of evening aspart insulin by 10%

D. Introduction of insulin glargine at a dose of 12 units in place of evening NPH insulin

E. Substitution of both dose of NPH insulin with one pre-breakfast dose of 20 units of insulin glargine

Back

D. Introduction of insulin glargine at a dose of 12 units in place of evening NPH insulin

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NPH insulin = Isophane (intermediate acting insulin)

Insulin glargine = Optisulin (long acting insulin)

CGPT (D)

A. Omit evening NPH insulin - leads to inadequate basal insulin control and worse glycemic control

B. Change time of evening NPH insulin to before evening meal - will not address nighttime hypoglycaemia and not optimal basal insulin coverage

C. Reduction of evening aspart insulin by 10% - reduces risk of hypoglycaemia, but not inadequate basal insulin coverage

E. Substitution of both dose of NPH insulin with one pre-breakfast dose of 20 units of insulin glargine - insufficient basal insulin coverage during day, and increases risk of hypoglycaemia overnight

Tags:

#Endocrinology #QUERY #T1DM

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