Rationale of the Week | Hypoglycemia Before Meal; Best Approach?
For last week’s practice question, we quizzed participants on Hypoglycemia before meals. 37% 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 has type 1 diabetes and is worried how to best adjust insulin to address hypoglycemia and prevent future episodes. They tell you that their blood sugar yesterday before lunch was 67 mg/dL and they were getting ready to eat 45 gms of carb and cover with 3 units of insulin.
JR asks, what is the best strategy in this situation? What action do you advise JR to take?
Answer Choices:
- Eat 15 gms of carbohydrates first to get blood sugar above 70, then cover with three units of bolus insulin and eat meal.
- Decrease bolus insulin by about one unit, inject insulin then immediately eat meal.
- Eat intended meal starting with carbs first, then take three units of insulin after completing meal.
- All of the above could be options.
- Only A or B are correct.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 20.43% chose this answer. “Eat 15 gms of carbohydrates first to get blood sugar above 70, then cover with three units of bolus insulin and eat meal.” This standard intervention, often referred to as the “rule of 15”, is a safe approach that is certainly a correct option.
Answer 2 is incorrect. 12.07% of you chose this answer. “Decrease bolus insulin by about one unit, inject insulin then immediately eat meal.” This standard intervention is also a safe approach that is certainly a correct option.
Answer 3 is incorrect. About 10.22% of respondents chose this. “Eat intended meal starting with carbs first, then take three units of insulin after completing meal.” This creative intervention is certainly a viable option that JR could choose.
Answer 4 is correct. 36.74% chose this answer. “All of the above could be options.” YES, this is the BEST answer. People with type 1 diabetes can use a variety of approaches to address and treat hypoglycemia. As diabetes care and education coaches, we take a person-centered approach, leaning into the individual’s expertise. If an approach is safe and fits into JR’s lifestyle and comfort zone, we are going to support their decision. We also keep the door open to reviewing the impact of the approach and engaging in collaborative problem solving as needed.
Finally, Answer 5 is incorrect 20.54% of you chose this answer. “Only A or B are correct.” Not quite the best answer since people with type 1 diabetes can use a variety of approaches to address and treat hypoglycemia. As diabetes care and education coaches, we take a person-centered approach, leaning into the individual’s expertise. If an approach is safe and fits into JR’s lifestyle and comfort zone, we are going to support their decision. We also keep the door open to reviewing the impact of the approach and engaging in collaborative problem solving as needed. That is why the answer choice “C” could also be correct. JR might be most comfortable with taking the insulin after the meal to avoid another hypoglycemic event.
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!
Want to learn more about this practice question?
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