Basal Insulin Case 1

CE / CME

The Role of Basal Insulin in the Modern Era of Diabetes Management: Interactive Case Challenge 1

ABIM MOC: maximum of 0.75 Medical Knowledge MOC point

Physician Assistants/Physician Associates: 0.75 AAPA Category 1 CME credit

Nurses: 0.75 Nursing contact hour

Physicians: maximum of 0.75 AMA PRA Category 1 Credit

Released: October 26, 2023

Expiration: October 25, 2024

Richard E. Pratley
Richard E. Pratley, MD

Activity

Progress
1
Course Completed

History  
A 65-year-old woman is referred to endocrinology by her primary care provider because of inability to meet glycemic targets. Her past medical history includes type 2 diabetes, obesity, osteoarthritis, and hypertension, and medications include metformin 1000 mg twice daily, empagliflozin 25 mg daily, semaglutide 2.0 mg weekly, atorvastatin 40 mg daily, lisinopril 20 mg daily, and acetaminophen 500 mg twice daily. 

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Current Presentation 
The patient provides a fasting blood glucose (FBG) log showing an average blood glucose of 190 mg/dL. She reports tolerating her current medications and adherence. She denies symptoms of hypoglycemia but is concerned about starting insulin, as she has heard it causes weight gain and is trying to lose weight. She reports losing approximately 20 lb since starting semaglutide 6 months ago and incorporating lifestyle changes including following a low-carbohydrate diet and walking 3 times weekly. Her current vitals are blood pressure 127/70 mm Hg; pulse 72 beats/min; height 5 ft, 5 in; weight 205 lb; BMI 34.1 kg/m2. Recent labs show A1C 9.2%, urine albumin–creatinine ratio 20 mg/g, and estimated glomerular filtration rate 85 mL/min/1.73 m2. Her total cholesterol was 240 mg/dL, low-density lipoprotein 136 mg/dL, high-density lipoprotein 40 mg/dL, triglycerides 250 mg/dL. All other labs are within normal limits. She has Medicare Part D insurance and is on a fixed income because of her recent retirement.

Question 1

Which of the following additional interventions would be best for this patient at this time to improve blood glucose control?