【Weekly Doctor Questions】Patients with a history of diabetes and chronic obstructive pulmonary disease have hyperglycemia, what is the best management strategy?

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Your valuable comments and suggestions will be our best help! A 60-year-old man with a history of type 2 diabetes and chronic obstructive pulmonary disease (COPD) was admitted to the hospital with COPD worsening
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The patient's medications included insulin glargine (40 U per day), metformin (two times per day, 1000 mg), as well as fluticasone and salmeterol inhalers
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The patient reported a recent glycosylated hemoglobin level of 7.
0% (reference range is 3.
8~5.
6)
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Physical examination: The patient has mild breathing difficulties, body temperature is 37.
9°C, blood pressure is 146/90 mmHg, heart rate is 102 beats/min, respiratory rate is 22 beats/min, and oxygen saturation is 90% under the condition of nasal cannula oxygen inhalation of 4L/min
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The patient is 165.
1 cm tall, weighs 79 kg, and has a BMI of 29
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Wheezing can be heard in both lungs, but no signs of lung consolidation
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The patient started taking levofloxacin, prednisone (60 mg daily), and nebulized salbutamol and ipratropium bromide
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Daily use of insulin continued, and metformin was discontinued
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On the second day of admission, the blood glucose level at random was between 200 and 300 mg/dL (reference range, <140)
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Which of the following is the best treatment strategy for this patient’s hyperglycemia? A.
Divide the dose of insulin glargine into two halves and administer it twice a day.
B.
Increase mealtime insulin.
C.
Replace prednisone with an equivalent dose of dexamethasone.
D.
Start a single long-acting sulfonylurea drug.
Treatment E.
The answer to the question of increasing the dose of insulin glargine is actually hidden in the stem and abstract
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