Insulin Dosing Question

[student 123]

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Hi All,

I have a question from a sample paper and will appreciate if you can help me with this:

A 22 year old female with Diabetes was put on Lispro 10U at Breakfast and Dinner and NPH 16U at Breakfast + 14 U at H.S.

Her readings over the last 2 weeks are:
Time Mean Plasma Glucose Reading
07:00 180-200
12:00 100-140
17:30 90-140
21:30 100-120
03:00 40-60

What should be the best option from below based on above readings:
1. Increase Morning lispro Dose
2. Increase Morning NPH Dose
3. Increase Dinner Lispro Dose
4. Increase H.S. NPH dose
5. Decrease H.S. NPH Dose

I think, the answer is either 1 or 5 (Increase Morning Lispro Dose, Decrease H.S. NPH Dose). This is because of the high reading at 7am and very low mean glucose reading at 3:00. I will appreciate your help with a reasoning.

Thanks

 

[rxblitzrx]

i vote for 5. too close to hypoglycemic readings at 3am.

 

[owlegrad]

i vote for 5. too close to hypoglycemic readings at 3am.

I agree. Not sure how it changes from 40-60 to 180-200 (breakfast? Lispro waring off?), but I think the potential for hypoglycemia is the more pressing issue in this case.

 

[rxblitzrx]

"Somogyi effect. The term refers to pattern of high morning sugars preceded by an episode of hypoglycemia (with no symptoms). Your blood sugar may drop too low in the middle of the night, so your body counters by releasing hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack."

 

[student 123]

Thanks rxblitzrx and owlegrad..I appreciate your help...

 

[oh no dont stop]

while we want to control out patients as best as possible, TOO much is always a bad thing. Especially with insulin. Therefore I would decrease the HS NPH dose. We can always tweak wake-time insulin to fit his sugars later