dxtxpx
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A pt with IDDM injects a mixture of NPH insulin and regular insulin before breakfast (7am) and before dinner (5pm) each day. She reports the following average self-monitored blood glucose levels from past week
TIME: BLOOD GLUCOSE LEVEL (mg/dl)
7 am: 115
11 am: 190
5 pm: 135
10 pm: 185
These data indicate that pt should adjust her insulin regimen by
a) increasing 7 am dose of NPH insulin
b) increasing both 7 am and 5 pm doses of NPH
c) increasing 7 am dose of regular insulin
d) increasing 5 pm dose of regular insulin
e) increasing both 7 am and 5 pm doses of regular insulin
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| peekay
Forum Guru
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seems like pt is becoming resistent to regular insulin.i will choose increasing regular insulin dose in the morning.
ANS= C
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| dxtxpx
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how will that help his 10pm hyperglycemia?
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| uscan
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E?
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| md2besoon
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](*,) e?
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| dxtxpx
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yes its E
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| asmi
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yep E should be the answer 
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| dxtxpx
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Yes E is correct
This pt should increase both 7 am (pre-breakfast) and 5 pm (pre-dinner) doses of crystalline regular insulin. The dosage of rapid-acting regular insulin administered before breakfast and dinner can be adjusted on basis of pre-lunch and bedtime blood glucose values, because the peak effect of regular insulin injections will occur at these times. Because both the pre-lunch and bedtime glucose levels are significantly elevated, both does of regular insulin should be increased.
The dosage of NPH can be monitored using pre-dinner and pre-breakfast blood glucose determinations, because the morning and evening NPH injections will have their peak effect at these times. Because both pre-dinner and pre-breakfast levels are normal, there is no need to adjust NPH dosage
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| peekay
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thanks for the explanation.it was a good qs.
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| doctor_tanya23
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is this a step 1 question i have done this when i was preparing for step 2.
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| dxtxpx
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i dunno, it was in old BSS (board simulator series) step1 book.
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