In a patient with type 2 diabetes presenting with elevated noon blood sugar, which insulin dose should be increased?

In patients with type 2 diabetes who are experiencing elevated blood sugar levels at noon, it is important to consider the timing of insulin administration and the action of the specific types of insulin involved.

The regular insulin dose, which typically has a rapid onset and peaks around 2 to 4 hours after administration, plays a crucial role in managing postprandial blood glucose levels—those that occur after meals. Increasing the morning regular insulin dose can help control the blood glucose spikes that are noticed at noon, particularly if the patient's hyperglycemia at this time is a result of insufficient coverage during morning meals.

In contrast, adjusting the morning NPH or evening doses of insulin might not directly address the elevated blood sugar occurring specifically at noon. NPH insulin has a peak action later in the day and is typically used for basal glucose control rather than immediate postprandial control. Increasing evening doses would not affect noon readings, as their action would peak after the time in question. Therefore, increasing the morning regular dose is an effective approach to manage midday hyperglycemia by providing appropriate coverage for carbohydrate intake during breakfast and early lunch.