Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – D2

ANSWER — 

Incorrect.

The patient needs more insulin. Assuming conservatively a dose requirement of 0.8 units/kg for a patient with obesity and type 2 diabetes, the estimated dose requirement is 72 units per 24 hours for this patient. The problem is not the need for multiple daily injections. Having started with a schedule of 70/30 insulin before breakfast, the next step is to increase the dose. Because the glucose values are elevated at all times of day, there is no evidence to justify a split schedule of insulin injections. (Such evidence might be the achievement of satisfactory glucose values before dinner, the time of peak action of the morning 70/30 insulin, but not at other times such as bedtime or before breakfast.) Hypoglycemia is unlikely to occur because of the low dose of insulin at this time.

Return to the previous choice to try again. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – A3".)