This article originally posted 10 February, 2009 and appeared in Issue 455
Test Your Knowledge Issue 455
A 51-year-old woman with long-standing, well-controlled type 2 diabetes is evaluated because of an oral temperature of 38.9 °C (102 °F) of 8 hours' duration and nausea.
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She began a basal-bolus insulin plan 6 months ago. Now she is concerned because her blood glucose level is 250 mg/dL (13.88 mmol/L). She says she is afraid to take her insulin because she may become hypoglycemic if she cannot eat. She has no ketone strips at home. Her last measured hemoglobin A1C value was 6.5%.
Which of the following strategies should the patient use to adjust her insulin while her illness persists?
A. Omit insulin during this period of nausea
B. Reduce the basal-bolus insulin dosage to adjust for blood glucose results
C. Maintain the basal-bolus insulin dosage
D. Take a “sick-day booster” of insulin if the blood glucose is greater than 250 mg/dL (13.88 mmol/L)
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