#july2020mccqe1
A 31-year-old Asian American man presents to the clinic for an annual physical. He has a 19-year history of type 1 diabetes, requiring 10 units NPH insulin each morning and 8 units NPH in the evening, with frequent blood glucose checks and regular insulin dosing throughout the day. He does not keep a log of his blood glucose values. A urine dipstick test shows 2+ albumin. His hemoglobin A1c (HbA1c) is 7.9%. Which of the following is the most appropriate next step in management to prevent morbidity?
(A) Add a standing regular insulin dose at lunchtime
(B) Begin ACE inhibitor therapy
(C) Discuss options for using an insulin pump
(D) Increase his morning NPH insulin dose
(E) Send a 24-hour urine collection specimen for total protein
A 31-year-old Asian American man presents to the clinic for an annual physical. He has a 19-year history of type 1 diabetes, requiring 10 units NPH insulin each morning and 8 units NPH in the evening, with frequent blood glucose checks and regular insulin dosing throughout the day. He does not keep a log of his blood glucose values. A urine dipstick test shows 2+ albumin. His hemoglobin A1c (HbA1c) is 7.9%. Which of the following is the most appropriate next step in management to prevent morbidity?
(A) Add a standing regular insulin dose at lunchtime
(B) Begin ACE inhibitor therapy
(C) Discuss options for using an insulin pump
(D) Increase his morning NPH insulin dose
(E) Send a 24-hour urine collection specimen for total protein
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