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Nocturnal hypoglycaemia with rebound hyperglycaemia — SCE Endocrinology MCQ

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ModerateDiabetes mellitusNocturnal hypoglycaemia with rebound hyperglycaemiaSCE Endocrinology

A 23-year-old woman with type 1 diabetes reports recurrent early-morning hyperglycaemia. Overnight capillary readings show 03:00 glucose 3.1 mmol/L followed by 07:00 glucose 14.8 mmol/L. She uses evening intermediate-acting insulin. What is the most appropriate management?

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Correct answer: B — Reduce or adjust evening basal insulin to prevent nocturnal hypoglycaemia

Reduce or adjust evening basal insulin to prevent nocturnal hypoglycaemia is best because the pattern suggests morning hyperglycaemia after nocturnal hypoglycaemia, so the basal regimen should be adjusted to prevent the overnight low. The alternatives are less appropriate because increasing basal insulin worsens the trigger; sulfonylureas are inappropriate; skipping bolus insulin causes hyperglycaemia; metformin monotherapy is unsafe in type 1 diabetes. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG17