What is the appropriate insulin adjustment if fasting glucose levels are high?

When fasting glucose levels are high, the appropriate adjustment is to increase the long-acting insulin dose, typically administered at bedtime. Long-acting insulin is designed to provide a steady release of insulin over a 24-hour period, helping to control blood sugar levels throughout the day and night.

In cases where fasting glucose levels are elevated, it suggests that the basal insulin needs are not being met adequately. Increasing the long-acting insulin dosage allows for better control of blood sugar levels during the fasting state and can prevent hyperglycemia in the morning. This adjustment is essential for patients managing diabetes, as maintaining optimal fasting glucose levels is crucial for overall glycemic control and reducing the risk of complications associated with high blood sugar.

Other options, such as increasing short-acting insulin at meals or decreasing long-acting insulin, would not adequately address high fasting glucose levels. Increasing short-acting insulin primarily influences post-prandial (after meal) glucose levels rather than fasting levels, while decreasing long-acting insulin would likely worsen fasting hyperglycemia. Therefore, the most effective and appropriate action in this scenario is to increase the long-acting insulin at bedtime.