🏥 USMLE Exam Prep

A 48-year-old female with a long history of Type 1 Diabetes Mellitus presents with recurrent episodes of nocturnal hypoglycemia despite meticulous glucose monitoring and adjustment of her insulin pump basal rates. Her HbA1c is 7.2%. What is the most appropriate initial adjustment to her insulin regimen?

A Increase the evening basal insulin rate.
B Decrease the evening basal insulin rate.
C Switch from insulin pump therapy to multiple daily injections.
D Add a long-acting sulfonylurea at bedtime.

✓ Correct Answer: Option B

Recurrent nocturnal hypoglycemia suggests that the evening basal insulin rate is too high. The most appropriate initial adjustment is to decrease this rate to prevent further episodes, especially given her reasonable HbA1c.

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