Type 1 Diabetes Mellitus: The Daily PANCE Blueprint
A 32-year-old male with a 10-year history of Type 1 Diabetes Mellitus (T1DM) presents to your clinic for a routine follow-up. He has been managing his diabetes with multiple daily insulin injections (MDI), including long-acting basal insulin at night and rapid-acting insulin before meals. He checks his blood glucose four times a day and occasionally experiences mild hypoglycemia, which he manages with quick-acting carbohydrates. His most recent HbA1c was 7.2%. He expresses interest in optimizing his diabetes management and reducing his hypoglycemic episodes. Which of the following would be the most appropriate next step in his diabetes management?
A. Switch to a continuous subcutaneous insulin infusion (CSII) pump.
B. Increase the dose of his basal insulin.
C. Transition to a regimen of conventional human insulin.
D. Initiate continuous glucose monitoring (CGM).
E. Advise him to reduce carbohydrate intake at each meal.
Answer and topic summary
The answer is D. Initiate continuous glucose monitoring (CGM)
For a patient with T1DM already on an MDI regimen and experiencing mild hypoglycemia, the initiation of continuous glucose monitoring (CGM) is a beneficial next step. CGM provides real-time glucose readings, trends, and alerts, which can help in the early detection and prevention of hypoglycemia. It also aids in more precise insulin dosing and can improve overall glycemic control. This approach aligns with the intensive diabetes therapy model, which emphasizes frequent monitoring and adjustment of insulin based on glucose levels. While CSII can offer more precise insulin delivery and flexibility, it may not be immediately necessary for this patient, especially if he is comfortable with his current MDI regimen and only experiencing mild hypoglycemia. Dietary adjustments can be part of diabetes management, but this advice alone does not address the immediate need for better glucose monitoring and may not be sufficient to optimize his diabetes control. Increasing basal insulin without proper glucose monitoring could increase the risk of hypoglycemia, and transitioning to a regimen of conventional human insulin would represent a step backward in the management of his diabetes.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Endocrinology ⇒ ⇒
Also covered as part of the Family Medicine EOR and Emergency Medicine EOR topic list
