What is the management approach for a patient with nasopharyngitis who is taking Lyumjev (insulin lispro-aabc) and Toujeo (insulin glargine)?

Management of Nasopharyngitis in Patients Taking Lyumjev and Toujeo

Nasopharyngitis in patients on insulin therapy (Lyumjev and Toujeo) requires symptomatic treatment only, as this is a viral upper respiratory infection that does not necessitate antibiotics or insulin regimen changes unless the patient develops significant illness affecting oral intake or glycemic control.

Symptomatic Management

• Analgesics and antipyretics such as acetaminophen or NSAIDs should be used for moderate to severe symptoms or fever control 1
• Warm facial packs, steamy showers, adequate hydration, and adequate rest provide comfort measures 2
• Warm salt water gargles can provide symptom relief for patients old enough to gargle 1
• Topical agents containing anesthetics (ambroxol, lidocaine, benzocaine) may provide temporary symptomatic relief 1
• Sleeping with the head of the bed elevated may improve comfort 2

Critical Distinction: Viral vs. Bacterial Infection

• Nasopharyngitis is typically viral and does not require antibiotic therapy 2, 1
• Testing for Group A Streptococcus is not necessary when clinical features strongly suggest viral etiology, including cough, rhinorrhea, hoarseness, and oral ulcers 1
• Antibiotics provide no benefit for viral pharyngitis and contribute to antibiotic resistance 1

Insulin Management Considerations

• Continue both Lyumjev (rapid-acting insulin lispro-aabc) and Toujeo (long-acting insulin glargine) at current doses unless the patient develops complications 2, 3
• Monitor blood glucose more frequently during acute illness, as viral infections can affect glycemic control 4
• If the patient develops poor oral intake, temporary insulin dose adjustments may be needed to prevent hypoglycemia 4
• If hyperglycemia develops (blood glucose >180 mg/dL), additional correction doses of rapid-acting insulin may be warranted 4

When to Escalate Care

• Contact physician if symptoms worsen, especially with severe headache, high fever, or symptoms not improved within 3-5 days 2
• Evaluate for bacterial sinusitis if purulent nasal discharge persists beyond 10 days or worsens after initial improvement 2
• Consider bacterial pharyngitis only if sudden onset of fever, cervical lymphadenopathy, and absence of cough or nasal symptoms develop 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics for uncomplicated viral nasopharyngitis 1
• Do not discontinue insulin therapy during minor viral illness unless specifically directed by a physician 2
• Do not use aspirin if the patient is a child due to risk of Reye syndrome 1
• Do not routinely use corticosteroids, as they provide only minimal symptom reduction (approximately 5 hours) with potential adverse effects 1
• Do not assume insulin requirements remain unchanged during illness; increased monitoring is essential 4