Interactive diabetes case 1: Inpatient management in type 1 diabetes

Case — A 60-year-old woman with a 48-year history of type 1 diabetes was admitted to the hospital for syncope. The patient had been on a diabetic diet in a nursing home, where she lived because of severe autonomic neuropathy with orthostatic hypotension. The syncope was ultimately attributed to the autonomic neuropathy and treated with midodrine.

She had been on NPH insulin 15 units and regular insulin 5 units before breakfast, regular insulin 5 units before dinner, and NPH insulin 6 units at bedtime. Her glucose control on this regimen had been satisfactory for her setting, with only occasional insulin reactions. The glycated hemoglobin (A1C) on admission was 7.8 percent.

On the first full hospital day, the 6:30 AM blood glucose level was 101 mg/dL (5.6 mmol/L). You advise which of the following?

●Hold NPH insulin due to hypoglycemia and cover with sliding scale. (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – A1".)

●Give NPH insulin 15 units and regular insulin 5 units before breakfast, her usual doses. (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – A2".)

●Give NPH 10 units before breakfast, begin 5 percent dextrose intravenously at 100 cc/hour, and keep patient nil per os (NPO). (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – A3".)