Interactive diabetes case 7: Management of diabetes in a 72-year-old patient with type 2 diabetes, GI bleeding, and multiple other medical problems – A1

ANSWER — Incorrect.

The patient calls in four days because his diabetes "has gone crazy." The glucose values before breakfast are in the 200 to 240 mg/dL (11.1 to 13.3 mmol/L) range and those before supper are in the 250 to 290 mg/dL (13.9 to 16.1 mmol/L) range. You advise more frequent testing of the blood glucose level, provide an insulin sliding scale with lispro insulin for short-term use, restore the NPH doses to previous levels, and advise the patient to call you with the glucose levels in several days. After you hang up, you review his previous glycated hemoglobin (A1C) levels and find that they were in the 7.30 percent to 7.90 percent range until the onset of gastrointestinal (GI) bleeding.

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