Rationale of the Week | Best Action to Avoid Thanksgiving Post Meal Elevation?
Happy Thanksgiving everyone!
For last week’s practice question, we quizzed participants on avoiding Thanksgiving post meal elevation. 78% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR is excited about enjoying Thanksgiving with family but is a little worried about post-Thanksgiving meal blood sugar elevations. JR takes 1 unit bolus insulin for every 10 gms of carb, with a correction factor of 1 unit for every 50 points above 120, plus 23 units of basal insulin at night. For Thanksgiving JR plans to eat:
- 1 cup of mashed potatoes
- Spoonful of green beans
- Gravy
- 1 Roll with lots of butter
- ½ cup of sweet potatoes
- Turkey leg
- A glass of white wine
If JR’s blood Sugar is 173 before the meal, what is the best approach?
Answer Choices:
- Decrease carbs by half and increase intake of high fiber vegetables.
- Take about 7-8 units bolus insulin before the meal.
- Increase basal the night before to prevent post meal elevation.
- Take bolus insulin after meal based on blood sugar response.
Getting to the Best Answer
Answer 1 is incorrect. 11.11% chose this answer. “Decrease carbs by half and increase intake of high fiber vegetables.” Although it is always a great idea to start the meal with high fiber foods to help regulate post meal glucose, we are not big fans of asking JR to reduce their carb intake by half on Thanksgiving. As long as JR takes adequate bolus insulin before the meal, they can enjoy Aunt Martha’s mashed potatoes and some of their favorite stuffing too.
Answer 2 is correct. 78.10% of you chose this answer. “Take about 7-8 units bolus insulin before the meal.” YES, this is the best answer. Trying to gauge exactly how much carbs is in a holiday meal is challenging, but it appears that this meal contains about 65-80 gms of carb. Since JR takes 1 unit of insulin for every 10 gms of carb, they will need about 7-8 units of insulin to cover this holiday feast.
Answer 3 is incorrect. About 3.59% of respondents chose this. “Increase basal the night before to prevent post meal elevation.” This isn’t the best answer, because increasing the basal the night before might cause morning hypoglycemia and isn’t designed to cover post meal elevations.
Finally, Answer 4 is incorrect. 7.19% chose this answer. “Take bolus insulin after meal based on blood sugar response.” Since JR is worried about post meal glucose elevations, the most effective strategy to prevent that from happening is to take the insulin bolus at least 15 minutes before the meal.
Happy Thanksgiving everyone! We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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