Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes - B4

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 bedtime NPH insulin schedule, the next step is to increase the dose. Hypoglycemia is unlikely to occur because of the low frequency of hypoglycemic reactions with bedtime NPH insulin in type 2 diabetes and 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 (for syringes, for example), all of which are associated with decreased patient adherence in patients with diabetes, as in other chronic disorders. The patient does not need multiple injections of a very short-acting insulin at this time. (However, she will probably need a more intensive insulin regimen in the future.)

Return to the previous choice to try again. (See "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes – A1".)