Interactive diabetes case 9: Management of type 1 diabetes in a patient on glucocorticoid therapy – B2

ANSWER — Correct.

The patient's blood glucose values improve somewhat over the next two days. The values are as follows: before breakfast 82 and 126 mg/dL, before lunch 252 and 184 mg/dL, before supper 153 and 197 mg/dL, and at bedtime 126 and 166 mg/dL.

What would you do at this juncture?

●Based on the amount of correction insulin given, you increase the dose of NPH before breakfast to 30 units every morning and continue the other doses, including the correction factor. Also, at this time, the dose of prednisone is reduced to 40 mg every morning. (See "Interactive diabetes case 9: Management of type 1 diabetes in a patient on glucocorticoid therapy – C1".)

●Because the highest values are still those before lunch, you increase the prandial (pre-meal) dose of regular insulin before breakfast to 16 units. Based on the dose of regular insulin given in accordance with the correction factor at 12:00 PM and the persistent hyperglycemia before supper, you add a prandial dose of regular insulin 12 units before lunch and continue the other doses of insulin including the correction factor as before. The patient's new regimen is NPH 20 units and regular 16 units before breakfast, regular 12 units before lunch, regular 10 units before supper, and NPH 6 units at bedtime. Also, at this time, the dose of prednisone is reduced to 40 mg every morning. (See "Interactive diabetes case 9: Management of type 1 diabetes in a patient on glucocorticoid therapy – C2".)