For a patient on long-acting insulin with elevated blood sugars, which blood sugars are crucial to review to adjust insulin dosage?

In managing a patient on long-acting insulin, reviewing the patient’s fasting blood sugar levels is essential for adjusting insulin dosage. The morning fasting blood sugar provides a clear indication of how well the patient’s basal insulin regimen is functioning overnight and throughout the night. If the fasting blood sugar is consistently elevated, it suggests that the long-acting insulin dosage may need to be increased to better control the patient’s blood glucose levels.

Fasting blood sugars reflect the body’s metabolic state after a period without food intake, making them particularly valuable for assessing the effectiveness of long-acting insulin. This information is critical since it can indicate whether the insulin is providing adequate coverage during the fasting state, which can help prevent hyperglycemia throughout the day.

In contrast, postprandial or 2-hour post-meal blood sugars can provide insights into the effectiveness of mealtime insulin or the patient’s carbohydrate intake, but they do not give the same direct feedback regarding the basal insulin's performance. Similarly, nocturnal blood sugars might provide some relevant information, but they are less reliable on their own without considering the fasting levels. Thus, focusing on the morning fasting blood sugar is the most crucial for making appropriate adjustments to long-acting insulin doses.