]> 2026-07-31T07:51:28+00:00 WBR0919 0 en Increasing the evening dose of NPH insulin further '''Incorrect'''-Increasing the evening dose of NPH insulin further might not be helpful since a previous attempt did not turn improve the patients condition. Administering glargine as late as possible during evening '''Incorrect'''-The onset of action of glargine is 3 to 4 hours and its duration of action is 22 to 24 hours. So administering it as late as possible during the evening will not be useful. Increasing the morning dose of NPH insulin '''Incorrect'''-Only increasing the evening dose of insulin will be helpful in treating Dawn phenomenon and not the morning dose. Advising the patient not to eat late in the night '''Incorrect'''-The patient already adheres to his strict diet schedule, which will include avoidance of late night eating. Add metformin '''Correct'''-After confirming the dawn phenomenon, if the patient is not responding to adjusted dosage of evening medication (increased evening NPH insulin dose) and switching over to a longer acting insulin (glargine) during the evening, adding metformin will be the next best step in management since metformin inhibits liver glucose production. Community Medical Health Center Primary Care Office Inpatient Facilities Vendhan Ramanujam A 26 year old Caucasian male comes to his physicians office for his regular checkup. He is a known type 1 diabetes mellitus patient for the past four years who was on NPH insulin, 30 U each morning and 15 U every night. But following a persistent morning glycosuria that did not improve, the evening dose was increased to 20 U during his last visit. He strictly adheres to his diet schedule. His following lab tests reveal worsening of his morning glycosuria with moderate ketones in his urine. Several consecutive nights glucose monitoring did not reveal any hypoglycemia. He is diagnosed with hyperglycemia due to reduced sensitivity to insulin and increase in early morning catabolic hormones called as dawn phenomenon. The evening dose of NPH is switched over to glargine. But neither did this help. What will be the next step in management of this patient E Endocrine 2020-10-28T02:04:42Z 2459150.5865972 WBR0919