Interactive diabetes case 5: Insulin management in a 73-year-old patient with diabetes admitted to the hospital – A1

ANSWER — Incorrect.

On further inquiry, you learn that the patient has type 1 diabetes. She presented with diabetic ketoacidosis (DKA) and had a second episode of DKA six years ago when she had pneumonia. Age is not a criterion for diagnosis of type 1 diabetes, which can have its onset at any age. One cannot assume that an older patient treated with insulin has type 2 diabetes. She needs an intermediate or long-acting insulin at all times.

Her metabolic control was satisfactory at home. It has been rendered unstable in the hospital by the use of an insulin sliding scale as the sole source of insulin. An insulin sliding scale without provision of a basal (intermediate or long-acting) insulin is not a satisfactory method of treatment for a patient with type 1 diabetes and for many insulin-treated patients with type 2 diabetes. Since the patient is now eating and has received regular insulin to treat the blood glucose of 363 mg/dL on the day you see her, it is appropriate to resume her usual insulin regimen before dinner on December 5.

For additional information, see the comment at the end of this sequence. (See "Interactive diabetes case 5: Insulin management in a 73-year-old patient with diabetes admitted to the hospital – Comment".)

To explore the consequences of the other actions, return to the case at the beginning of this sequence. (See "Interactive diabetes case 5: Insulin management in a 73-year-old patient with diabetes admitted to the hospital".)