A 17-year-old young man, has T1DM for 9 years, has persistent morning hyperglycemia. He reports a good --- to diet and insulin. He is on insulin aspart 7 units at meals and insulin glargine 20 units at bedtime. His home blood glucose records show reasonable glycemic control except for morning hyperglycemia. His HbA1c is 7.7%. Which of the following is the most appropriate step to improve his morning high blood glucose?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: B. 3 Am blood glucose monitoring
Isolated morning hyperglycemia on basal–bolus insulin can be the dawn phenomenon (nocturnal GH surge → glucose high at 3 AM) or the Somogyi effect (nocturnal hypoglycaemia → rebound hyperglycaemia, glucose low at 3 AM). These need opposite changes to evening insulin, so first check the 3 AM glucose.
- Increasing glargine (C) without this check could worsen a Somogyi pattern.
- Changing mealtime aspart (A, D) does not address overnight/fasting glucose.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Aspart is a rapid-acting mealtime insulin (5-15 min before meals); overnight and fasting glucose is the job of the basal insulin.
✓ RT - DM.pdf · p. 5 -
B
ليش صح
Morning hyperglycaemia is first checked with a 3 am glucose: high means dawn phenomenon (raise evening insulin), low means Somogyi effect (lower it).
✓ Endocrine ✳️.pdf · p. 4 -
C
ليش غلط
If the 3 am glucose is low (Somogyi effect) the evening insulin should be decreased, so raising glargine without checking could make it worse.
✓ Endocrine ✳️.pdf · p. 4 -
D
ليش غلط
Breakfast aspart is a rapid-acting mealtime insulin and does not address the overnight rise; nocturnal glucose is controlled by the basal (10 PM) insulin.
✓ RT - DM.pdf · p. 5
- المصدر
- Endocrine ✳️.pdf · p. 4
- المحاضرة
- Diabetes Mellitus · Endocrinology · Module B
- ظهر في
- Endo bank