Case Studies – Diabetes Medications

00:01 Now, let's do a question. Let's do our first case here.

00:04 A 38-year-old woman wishes to have better control of her type 1 diabetes.

00:10 Her hemoglobin A1c is 11.2%, her fasting glucose is 216 mg/dL or 12.2 mmol/L in the metric units.

00:18 The urine is 1+ glucose and ketones.

00:22 She's currently on NPH insulin at night with regular insulin at mealtimes.

00:29 What is the most appropriate therapy? A, insulin regular twice a day with NPH at night, insulin glargine in the evening with lispro before meals, insulin NPH twice a day with regular insulin for breakthrough high sugar values, or insulin detemir before each meal with lispro at night.

00:50 Great, you picked insulin glargine in the evening with lispro before meals.

00:57 Remember that lispro is the short-acting version.

01:01 This woman was on an older regimen of that old regular insulin before each meal.

01:07 She was on NPH at night. Now, remember that NPH lasts about 8 hours and it can be used at night, and regular insulin before meals can be used for treatment of diabetes but I think that's an old regimen.

01:22 That was the mainstay of therapy once upon a time.

01:25 This regimen, honestly, is just an outdated regimen.

01:29 It wasn't achieving the goal and I think it's time to get into the new sentry.

01:33 So, regular insulin has been replaced mostly with short, short-acting agents such as lispro.

01:40 Glargine is appropriate either at night or in the morning.

01:44 Detemir is a long-acting agent and it's almost never used twice a day.

01:50 I think lispro shouldn't be used at night because you run the risk of hypoglycemia while the patient is sleeping.