Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – A4

ANSWER — 

Correct.

You increase the dose of NPH insulin gradually to 35 units before breakfast. However, the blood glucose levels do not change. What is your next step?

●Change to NPH 35 units daily at bedtime to reduce nocturnal hepatic glucose output and improve glycemia. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – E1".)

●Change to 70/30 insulin mixture 35 units before breakfast to provide some short-acting insulin before breakfast. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – E2".)

●Increase NPH insulin to 40 units before breakfast, then increase the dose by 5 units every five days or so until the pre-meal and bedtime glucose levels fall below 200 mg/dL (11.1 mmol/L), then call/email/fax results or return for further advice. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – E3".)

●Add lispro insulin 5 units before each meal and at bedtime. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – E4".)