Patients with diabetes mellitus (DM) who are acutely ill generally require which of the following?

Patients with diabetes mellitus who are acutely ill typically require a higher dose of insulin due to several physiological factors that arise during acute illness. When a person with diabetes becomes ill, whether due to infection, surgery, or other acute conditions, the body experiences increased stress and heightened levels of counter-regulatory hormones like cortisol, epinephrine, and glucagon.

These hormones promote insulin resistance, leading to elevated blood glucose levels. As a result, to manage and control hyperglycemia effectively during these stress responses, patients often need to increase their insulin dosage. This adjustment helps ensure that glucose levels do not reach dangerous heights, which can result in complications like diabetic ketoacidosis or hyperglycemic hyperosmolar state.

In contrast, a stable dose of insulin may not be adequate since the body’s needs change significantly during acute illness, and a lower dose would likely risk uncontrolled blood glucose levels. Additionally, there may be situations (like in certain infections) where some patients may require more intensive management and monitoring of their diabetes regimen, reinforcing the need for higher doses in acute settings.