Ask the Experts - Persistent Fasting Hyperglycemia but Normal...
Ask the Experts - Persistent Fasting Hyperglycemia but Normal...
I have under my care a 35-year-old woman with persistent fasting hyperglycemia (> 200 mg/dL) but normal postprandial blood glucose values. Her insulin regimen consists of 12 units of Mixtard 50 (50% regular insulin:50% isophane [NPH] insulin) in the morning and 24 units of Insulatard (isophane insulin) at night. How can I control her fasting blood glucose and what can be the cause of this phenomenon?
One would wonder how well documented is the finding of "normal postprandial blood glucose values." An additional possibility is that the patient is actually becoming hypoglycemic during the night (perhaps the evening dose is being taken at dinnertime rather than at bedtime) and exhibiting rebound hyperglycemia in the morning. Additional information from home glucose monitoring, particularly glucose levels at bedtime and during the night, and measuring HbA1c would be useful. With these caveats, it is not unusual for a patient to exhibit unusually high insulin requirements in the evening; therefore, increasing the dose of isophane insulin at bedtime would not be an unreasonable approach.
I have under my care a 35-year-old woman with persistent fasting hyperglycemia (> 200 mg/dL) but normal postprandial blood glucose values. Her insulin regimen consists of 12 units of Mixtard 50 (50% regular insulin:50% isophane [NPH] insulin) in the morning and 24 units of Insulatard (isophane insulin) at night. How can I control her fasting blood glucose and what can be the cause of this phenomenon?
One would wonder how well documented is the finding of "normal postprandial blood glucose values." An additional possibility is that the patient is actually becoming hypoglycemic during the night (perhaps the evening dose is being taken at dinnertime rather than at bedtime) and exhibiting rebound hyperglycemia in the morning. Additional information from home glucose monitoring, particularly glucose levels at bedtime and during the night, and measuring HbA1c would be useful. With these caveats, it is not unusual for a patient to exhibit unusually high insulin requirements in the evening; therefore, increasing the dose of isophane insulin at bedtime would not be an unreasonable approach.