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Type 1 Diabetes — RACP Paediatrics MCQ

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ModerateEndocrinologyType 1 DiabetesRACP Paediatrics

A 12-year-old girl with type 1 diabetes has an HbA1c of 9.5% (80 mmol/mol). She is on a basal-bolus insulin regimen. Her blood glucose diary shows fasting hyperglycaemia (12–15 mmol/L) and post-lunch spikes (18–22 mmol/L). Which adjustment is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Increase her basal insulin dose and lunch-time bolus

Fasting hyperglycaemia indicates insufficient basal insulin overnight. Post-lunch spikes indicate insufficient bolus insulin coverage at lunch. Increasing both the basal insulin dose (by 10–20% every 2–3 days) and the lunchtime bolus ratio is the most appropriate adjustment. Switching to premixed insulin reduces flexibility and is not recommended in T1DM management. Continuous glucose monitoring may help guide adjustments.

Reference: ISPAD – 2024 – Clinical Practice Consensus Guidelines: Type 1 Diabetes Management