A patient with IDDM injects a mixture of NPH insulin and crystalline zinc (Regular) insulin before breakfast (at 7 AM) and before dinner (at 8 PM) each day. She reports the following average self monitored RBS for the past week.
**Core Concept**
The patient has Insulin-Dependent Diabetes Mellitus (IDDM) and is on a regimen of mixed insulin, which includes NPH (Neutral Protamine Hagedorn) insulin and crystalline zinc (Regular) insulin. This regimen is designed to provide both basal and bolus insulin coverage.
**Why the Correct Answer is Right**
Since the correct answer choice is not provided, let's discuss the general approach to this scenario. The patient's insulin regimen includes NPH insulin, which has an onset of action around 2-4 hours, peaks at 4-12 hours, and lasts for about 12-18 hours. Regular insulin has a faster onset, peaking at 2-3 hours and lasting about 6-8 hours.
**Why Each Wrong Option is Incorrect**
**Option A:** This choice would be incorrect if it suggested a regimen that did not account for the patient's basal and bolus insulin needs.
**Option B:** Similarly, this choice would be wrong if it proposed a regimen that did not align with the patient's current insulin schedule or if it failed to address the patient's reported blood sugar levels.
**Option C:** This option would be incorrect if it recommended a change in the insulin regimen without considering the patient's specific needs or if it did not address potential issues with the current regimen.
**Option D:** This choice would be wrong if it suggested no changes to the regimen despite the patient's reported blood sugar levels.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that NPH insulin provides basal coverage, while Regular insulin acts as a bolus to cover meal-related spikes in blood glucose. Adjusting the ratio of NPH to Regular insulin or the timing of injections can significantly impact blood glucose control.
**Correct Answer:**