Interactive diabetes case 13: Deterioration of glycemia in a 59-year-old patient with type 2 diabetes complicated by retinopathy, nephropathy, and neuropathy – A2

ANSWER — Correct.

This is a reasonable approach to a patient with variable glucose values on a basal insulin dose alone. It should provide an adequate basal insulin dose and doses of a very short-acting insulin that are related to the patient's carbohydrate intake and the pre-meal glucose values.

However, it does not work. The patient now has satisfactory glycemia on some days and increased variability on other days, when he experiences both hyperglycemia and hypoglycemia.

What is your next action?

●You advise the patient to measure the blood glucose levels seven or eight times a day, both before and after meals and at 2 or 3 AM, to guide further adjustments in insulin therapy. (See "Interactive diabetes case 13: Deterioration of glycemia in a 59-year-old patient with type 2 diabetes complicated by retinopathy, nephropathy, and neuropathy – B1".)

●You order an abdominal computed tomography (CT) scan to evaluate his abdominal pain. (See "Interactive diabetes case 13: Deterioration of glycemia in a 59-year-old patient with type 2 diabetes complicated by retinopathy, nephropathy, and neuropathy – B2".)

●You seek more information from the patient and his wife about his gastrointestinal symptoms. (See "Interactive diabetes case 13: Deterioration of glycemia in a 59-year-old patient with type 2 diabetes complicated by retinopathy, nephropathy, and neuropathy – B3".)

●You refer the patient to a diabetes specialist for initiation of insulin pump therapy. (See "Interactive diabetes case 13: Deterioration of glycemia in a 59-year-old patient with type 2 diabetes complicated by retinopathy, nephropathy, and neuropathy – B4".)