This article originally posted 24 July, 2007 and appeared in Issue 374
Test Your Knowledge Issue 374
Barbara is a 68-year-old woman who has had type 1 diabetes for 5 years (type 1 diabetes can appear at any age). She is taking Levemir (long-acting basal insulin) twice a day and Novolog with each meal.
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Her carbohydrate-to-insulin ratio is 12 to 1 and her correction factor is 1:40 (1 unit of insulin will normally bring down her glucose value 40 mg/dl). Hannah also takes 10 units of Symlin before meals.
Barbara ate a late dinner at 8p.m. and at that time her glucose value was 245 mg/dl. She was planning on eating about 70 grams of carbohydrates. Her dose at dinnertime was 3 units as a correction dose for her elevated glucose value at dinnertime, plus 6 units for the number of carbohydrates consumed for dinner (total 9 units):
245 mg/dl Starting glucose level
-120 mg/dl Target glucose level
125 mg/dl Amount of glucose reduction needed in order to be at target level
125 mg/dl Amount of glucose reduction needed in order to be at target level
÷ 40 mg/unit Correction factor of 40 mg glucose reduction per unit
3 units Correction dosage Plus
70 grams Amount of glucose reduction needed in order to be at target level
÷ 12 grams/unit Insulin ratio
6 units Meal dosage
3 units (correction dosage) + 6 units (meal dosage for carbohydrate to be consumed) = 9 units total insulin
At 9:30p.m. Barbara confirmed with a fingerstick that her glucose value was 227 mg/dl. See the 1-hour and 3-hour glucose trend graphs in figures j and k below.
Overcorrecting for High Glucose: Which of the following options would you suggest for Barbara at this time based on the 1-hour and 3-hour glucose trend graphs? Barbara intends to go to bed at 10p.m. (Only one answer is correct)
A. Give another correction bolus of 3 units
B. Watch and wait
C. Increase the bedtime dose of her basal insulin Levemir by 10%
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