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Inpatient insulin management — SCE Endocrinology MCQ

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ModerateDiabetesInpatient insulin managementSCE Endocrinology

A 72-year-old woman with type 2 diabetes is admitted with pneumonia and poor oral intake. She usually takes insulin glargine 28 units at night and rapid-acting insulin with meals. She is now nil by mouth. What is the most appropriate inpatient insulin principle?

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

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Correct answer: A — Continue reduced basal insulin and use variable-rate insulin if needed

Basal insulin should generally continue, often at a reduced dose, to prevent ketosis and severe hyperglycaemia; variable-rate insulin may be needed while nil by mouth. Usual mealtime insulin while fasting risks hypoglycaemia. Stopping basal insulin is particularly dangerous in insulin-deficient diabetes.

Reference: JBDS Inpatient Diabetes Guidelines