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NCLEX Question of the Day
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A patient with type 1 diabetes takes insulin glargine (Lantus) 20 units at bedtime. The patient's fasting blood glucose level is consistently above 200 mg/dL. Which of the following is the most appropriate action?
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Correct answer Increase the Lantus dose by 2-4 units
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Add regular insulin at bedtime
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Change to insulin detemir (Levemir)
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Decrease the Lantus dose to 10 units
Rationale
The most appropriate action for a patient with consistently high fasting blood glucose levels on insulin glargine (Lantus) is to increase the Lantus dose by 2-4 units. Lantus is a long-acting basal insulin that helps to control blood glucose levels overnight and between meals.
If fasting glucose levels remain high, the Lantus dose should be titrated upward gradually until targets are reached. Adding regular insulin at bedtime would increase the risk of nocturnal hypoglycemia. Changing to insulin detemir (another long-acting insulin) would not necessarily improve glycemic control. Decreasing the Lantus dose would likely worsen fasting hyperglycemia.
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