]> 2026-07-31T16:29:07+00:00 WBR0264 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 out to be useful Switching from NPH to glargine during evening '''Correct'''-Early morning hyperglycemia without nocturnal hypoglycemia in diabetes mellitus patients who are on insulin is called as Dawn phenomenon. This is due to the increased body production of certain hormones (growth hormones, cortisol, catecholamines, glucagon and epinephrine) between 4 a.m. and 8 a.m., which suppress the activity of insulin and trigger the glucose release from liver. In non-diabetic people, the body responds to the excess glucose that accumulates as a result of this process by producing insulin. The insulin then moves the excess glucose into the cells. However, people with diabetes either fail to produce insulin or cannot properly use the insulin that is available. As a result, glucose continues to rise to abnormally high levels (hyperglycemia). The first step will be to monitor nocturnal blood glucose on several consecutive days, to rule out hypoglycemia that occurs due to Somogyi effect. After confirming, the next step in managing Dawn phenomenon will depend on the case. When the patient is not responding to adjusted dosage of evening medication (increased evening NPH insulin dose), the next best step will be to switching over to a longer acting insulin (glargine) during the evening. 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 '''Incorrect'''-Metformin inhibits liver glucose production and is effective in treating Dawn phenomenon. This will be the next step if including longer acting insulin to the evening dose did not help. 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. The next step in management of this patient will be B Endocrine 2020-10-27T23:59:51Z 2459150.4998958 WBR0264