Patient us a 50 y/o diabetic male is noncompliant with diet | Figure 1

Dura_Mater

Patient Case

Patient is a 50 y/o diabetic male who is noncompliant with diet and medication and had been out of Humalog for 1 week. Previous insulin regimen was Levemir 50U BID and Humalog "sliding scale" per patient, typically around 120U before meals. BP 160/108, pulse 108, resp 20, BMI 28.19. Patient is in no acute distress, no altered consciousness, no nausea, no weakness, or malaise at visit. Initially seen in the outpatient clinic where labs were ordered. Here are the results. What would you do?

Patient Images

Discussion Points

• Is it common practice to bump up a diabetic just to give them insulin? If so, why? Her BG at HS was 188 even without the dinner Apidra. Just curious why she should be given sugar just to get insulin.

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Call to Action

What are your thoughts on managing insulin doses in diabetic patients, especially when they are noncompliant?