Interactive diabetes case 9: Management of type 1 diabetes in a patient on glucocorticoid therapy – B3

ANSWER — 

Incorrect.

First of all, this is not an optimal time to change the types of insulin used by the patient. A conversion to a glargine and lispro regimen usually requires some adjustment of doses, even in a patient with well-managed diabetes. In the present case, this variable would then be added to the hyperglycemic effect produced by prednisone use. The patient's glycemia was well managed before the start of prednisone, so little is to be gained from conversion to glargine and lispro.

Secondly, an intermediate-acting basal insulin (in particular, NPH insulin) given in the morning is probably the preferred basal insulin for a patient treated with a short-acting glucocorticoid such as prednisone once daily in the morning. The time course of action of NPH insulin roughly approximates the time course of the hyperglycemic effect of a short-acting glucocorticoid such as prednisone.

Return to the previous choice to try again. (See "Interactive diabetes case 9: Management of type 1 diabetes in a patient on glucocorticoid therapy – A2".)