Diabetic control
55 year old male with t2DM for 5 years and history of ischemic stroke 3 years ago
BMI 29, HbA1 8.5%
Current medication: metformin 3 g/d, glibenlamide 20 mg/d, pioglitazone 30 mg/d
2. 55 year old male with t2DM for 5 years
and history of ischemic stroke 3 years
ago
BMI 29, HbA1 8.5%
Current medication: metformin 3 g/d,
glibenlamide 20 mg/d, pioglitazone 30
mg/d
Self monitoring of blood glucose
(SMBG):
NPH 10 unit before bedtime was added. The
SMBG after bedtime NPH were as followed
What would you do for the management of
this patient?
Breakfast Lunch Dinner Bedtime
171 135 128 126
Breakfast Lunch Dinner Bedtime
Day 1 209
Day 2 96 135 124 126
Day 3 205
Day 4 196 131 126
Day 5 189
3. Is this patient well controlled?
Does this patient require insulin?
How would you start insulin?
How do you titrate the insulin dose?
What do you do with the oral agents?
4. SMBG results into diabetes management can be a
tool for guiding medical nutrition therapy and
physical activity, preventing hypoglycemia, and
adjusting medications
SMBG reduced A1C by 0.25% at 6 months but the
reduction subsides after 12 months
10. Insulin therapy initiation: 10 units daily or by
weight-based equations.
Augmentation: 0.3 unit per kg
Replacement: 0.6 to 1.0 unit per kg.
ALLISON PETZNICK, Am Fam Physician. 2011 Jul 15;84(2):183-190