Question of Week | 90 years old and hungry. Best action?

HM is living with type 2 diabetes and is 90 years old with a BMI of 32.  HM’s most recent A1c was 9.3% and their GFR is 16.  The provider stopped the metformin due to the diminished kidney function and HM is currently on no diabetes medications.  To manage HM’s blood sugar, the provider ordered a low-calorie restrictive meal plan for HM.  HM was a chef for 40 years and tells you, “they feel hungry” all the time.  Based on this assessment, you decide to contact the provider.

Which of the following would be the best suggestion?

  • Ask provider to add a bedtime snack to reduce hunger.
  • Encourage HM to take a short walk after meals to reduce post prandial hyperglycemia.
  • Reassure HM that limiting calories is the best plan to keep blood glucose on target.
  • Contact provider with suggestion to start HM on once daily basal insulin.

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