Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – E2

ANSWER — 

Incorrect.

The patient needs more insulin. Assuming conservatively a dose requirement of 0.8 units/kg for a patient with obesity and type 2 diabetes, the estimated dose requirement is 72 units per 24 hours for this patient. The problem is not the choice of an insulin formulation. Having started with a regimen of NPH insulin before breakfast, the next step is to increase the dose. Hypoglycemia is unlikely to occur because of the low frequency of hypoglycemic reactions with NPH insulin before breakfast and the low dose of insulin at this time.

Return to the previous choice to try again. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – A4".)