A 67-year-old woman is seen for a follow-up visit. She has had several hypoglycemic episodes that have become increasingly frequent over the past 6 months. Her current medications are neutral protamine Hagedorn (NPH) insulin, 20 units, and regular insulin, 5units, both injected before breakfast and supper. A review of her glucose log shows blood glucose readings ranging between 70 and 150 mg/dL when fasting and 50 and 250 mg/dL during the day. Her last measured hemoglobin A1c value was 7.9%. Which of the following changes is most appropriate?
سؤال مجاني 2 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Change to insulin glargine and insulin lispro
She has frequent hypoglycaemia on twice-daily NPH + regular insulin, yet HbA1c (7.9%) is still above target. Switching to a basal-bolus analogue regimen (glargine + lispro) is best: glargine has no pronounced peak (unlike NPH), and basal-bolus regimens give better control with less nocturnal hypoglycaemia.
- Simply cutting doses by 10% would worsen an already above-target HbA1c; oral agents alone are not appropriate replacement for her insulin; increasing calories treats the symptom, not the cause.
ليش كل خيار صح أو غلط
-
A
ليش صح
Glargine gives 24-hour basal cover with no pronounced peak, whereas NPH is intermediate-acting (12 h) and dosed twice daily, so the switch gives steadier basal insulin to a patient with frequent lows.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 9 -
D
ليش غلط
Sugar-containing food is the acute treatment for a hypoglycaemic episode; the lecture also says to manage the underlying cause, here the insulin regimen causing repeated lows.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 23
- المصدر
- DM summary.pdf · p. 4
Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 9 - المحاضرة
- Hypoglycaemia · Endocrinology · Module B
- ظهر في
- Endo bank