What correction is needed for a fasting blood glucose level of 138 mg/dl?

Management of Fasting Blood Glucose of 138 mg/dl

For a fasting blood glucose level of 138 mg/dl, a correction dose of 2 units of rapid-acting insulin is recommended. 1

Assessment of the Blood Glucose Value

• A fasting blood glucose of 138 mg/dl is above the target range of 80-130 mg/dl recommended by the American Diabetes Association, indicating mild hyperglycemia that requires correction 2, 1
• This value falls into the category of mild hyperglycemia that should be addressed to prevent prolonged elevated glucose levels throughout the day 1
• Morning hyperglycemia may be due to the dawn phenomenon, inadequate basal insulin coverage, or rebound from overnight hypoglycemia 1

Recommended Correction Dose

• For a pre-breakfast blood glucose level of 138 mg/dl, a correction dose of 2 units of rapid-acting insulin is appropriate 1
• This correction dose should be administered before breakfast to address the current hyperglycemia 2
• Monitor blood glucose 2-4 hours after administration to assess effectiveness of the correction dose 1

Considerations for Ongoing Management

• If pre-breakfast hyperglycemia is recurrent, consider increasing the evening/bedtime basal insulin dose by 2-4 units every 3-7 days until fasting glucose consistently reaches target range (80-130 mg/dl) 1
• Avoid using only sliding scale insulin (correction insulin without basal insulin) as this approach is ineffective for long-term management 1
• For patients with type 2 diabetes, ensure that the basal insulin dose is optimized to achieve target fasting glucose levels 2

Special Considerations

• Be vigilant for hypoglycemia, especially 2-4 hours after administration when insulin action peaks 1
• If the patient is on glucocorticoid therapy, they may require higher insulin doses due to steroid-induced insulin resistance 1, 2
• For patients on NPH insulin and steroids, timing of insulin administration is critical - NPH action peaks at 4-6 hours after administration and should be given concomitantly with intermediate-acting steroids 2

Monitoring and Follow-up

• Continue monitoring blood glucose before meals and at bedtime to evaluate the effectiveness of the correction dose and overall glycemic control 2
• Document the response to the correction dose to help guide future insulin adjustments 1
• Evaluate the overall insulin regimen if hyperglycemia persists, considering whether basal insulin adjustments are needed 1

Common Pitfalls to Avoid

• Avoid excessive insulin administration that could lead to hypoglycemia, especially during overnight hours when hypoglycemia may go undetected 1
• Don't ignore patterns of morning hyperglycemia, as they may indicate the need for adjustment of the overall insulin regimen 1
• Consider the timing of insulin administration in relation to meals - administering insulin more than 45 minutes before breakfast is associated with higher risk of prelunch hyperglycemia 3