Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – D4

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 insulin schedule. Having started with a schedule of 70/30 insulin before breakfast, the next step is to increase the dose. Hypoglycemia is unlikely to occur because of the low dose of insulin at this time.

While the approach you have chosen will increase the total dose of insulin, it adds complexity, inconvenience, and cost (eg, for syringes), all of which are associated with decreased patient adherence in patients with diabetes, as in other chronic disorders.

Also, it is not rational and may be confusing to add a very short-acting insulin before breakfast to the short-acting insulin in 70/30 insulin.

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