T2DM: Outpatient Insulin Management

A 54-year-old man presents to the clinic for his annual preventive visit. He requests screening for T2DM stating that his brother was recently diagnosed with this. He denies any classic symptoms of hyperglycemia, including polyuria, polydipsia, blurry vision, or weight loss. Which of the following establishes a diagnosis of T2DM?

You have just diagnosed a 48 yo man with T2DM in your clinic after reported complaints of fatigue, thirst, frequent urination, and weight loss. His Hgb A1c is 12.2%. Based on recommendations from the ADA what do you recommend for initial treatment?

Insulin Practice 1: A 53 yo M pt with T2DM on metformin and a GLP-1 agonist presents for his annual visit. You perform blood work and find that his A1C is 9.7% and his weight is 110 kg (242 lbs). What insulin regimen should you start him on?

Insulin Practice 1.2: You started your patient on 22 units of insulin glargine daily. He returns to the office in 3 days and reports his fasting SMBG the last 3 mornings, including this morning, have been 188, 190, 181, respectively. What is your next step in managing his insulin?

Insulin Practice 1.3: You increased your pt's insulin regimen to 26 units of glargine daily and he returns 4 days later. He reports that his fasting SMBG have been 125, 110, 117, and 120. He has also been checking his BG 90 minutes after meals and reports they have almost all been in the 180s. What is your next step in managing his insulin?

Insulin Practice 1.4: After adding the 1 rapid-acting insulin injection, your pt's fasting and post-prandial SMBG numbers were at goal so you increase his interval follow up to 1 month. Unfortunately, a pandemic strikes so he doesn't follow up until 3 months later. He reports he has been doing well with diet and exercise despite the shutdowns and lost 15 lbs! He also reports occasional episodes of feeling anxious, sweaty, and a little lightheaded usually around bedtime. You review his SMBG logs and note occasional bedtime BG readings in the low 70s. The remainder of his readings are still within goal. What is your next step in managing his insulin?