You pt takes insulin glargine (Lantus) and has a treat to target self adjustment scale, with a fasting morning bg of <120 mg/dL. It has been three months since his last visit. Since then, his basal insulin dose has been self increased by 18 units (to 48 units QHS). Today, his BG meter shows that his fasting bg levels are still usually above target, sometimes within target, with an occasional hypoglycemic reading. Most bedtime glucose readings are well above target. You also notice that his weight has increased by 4 kg (about 9 lbs) since his last visit. What is the most likely explanation for these findings?
A. The pt requires additional basal insulin since most of his fasting morning readings are still above target. He should increase his dose of according to the algorithm
B. He requires additional basal insulin, but because he mistaking more than 40 units, he may benefit by having a split dose
C. Because he has some low readings (although few), he should decrease the dose and add bolus insulin during the day
D. As evidenced by his wt gain and continued high readings, the pt is likely overeating. Help the pt evaluate current eating patterns and make adjustments