What is the appropriate adjustment to insulin therapy indicated by increased blood sugar levels overnight?

When blood sugar levels are elevated overnight, it typically indicates that the long-acting insulin dosage may be insufficient to cover the metabolic needs during the night. In this scenario, increasing the long-acting insulin administered at night is the most appropriate adjustment. This type of insulin is designed to provide a steady release of insulin over an extended period, helping to manage blood sugar levels during the fasting state.

Adjusting the long-acting insulin can help maintain blood glucose levels within a target range overnight and combat the phenomenon known as the dawn phenomenon, where the liver produces glucose in the early morning hours. By increasing the long-acting insulin in the evening, it can improve the basal insulin coverage needed to stabilize blood sugar levels through the night into the morning.

Increasing short-acting insulin alone may not adequately address the overnight elevation in blood sugar, as short-acting insulin is typically used to manage food intake rather than provide basal coverage. Likewise, decreasing all insulin dosages would likely exacerbate hyperglycemia rather than correct it. Maintaining the current regimen without changes could lead to continued elevations in blood sugar levels without addressing the underlying issue.