Rationale of the Week | Premeal Glucose is Too Low

For last week’s practice question, we quizzed test takers on what to do when premeal glucose is too low. 49% of respondents chose the best answer. We want to 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: RL carb counts and takes 1 unit of insulin for every 10 gms of carbohydrate. RL also uses a correction ratio and takes 1 unit for every 40 points above their glucose target of 120.  RL’s asks you what to do if their premeal glucose is less than 70 before their lunch meal at work. RL often has blood sugar drops right before lunch and usually eats a sandwich, chips, berries and some sparkling water for lunch.

Given the situation, what is the best recommendation for JL to do if their pre-lunch glucose is less than 70 mg/g?

Answer Choices:

  1. Immediately eat 15gms of berries and recheck glucose in 15 minutes.
  2. Decrease usual insulin carb coverage for this meal by 1 or 2 units.
  3. Encourage RL to eat lunch immediately and give insulin afterward.
  4. Discuss which strategies would work best for RL in this situation.

As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally option 3.

Getting to the Best Answer

Answer 1 is incorrect. 21.42% chose this answer, “Immediately eat 15gms of berries and recheck glucose in 15 minutes.” This answer is a right answer, but it is not the BEST answer. Yes, we recommend treating low blood sugar with 15 gms of carbohydrate, but is this the preferred treatment strategy for RL? Would RL choose this option?

Answer 2 is incorrect. 17.11% of you chose this answer, “Decrease usual insulin carb coverage for this meal by 1 or 2 units.” This also could be a right answer, but it is not the BEST answer. When faced with a premeal low blood sugar, some people may choose to decrease their bolus insulin dose by 1-2 units, but is this the preferred treatment strategy for RL?

Answer 3 is incorrect. 12.72% of respondents chose this answer, “Encourage RL to eat lunch immediately and give insulin afterward.” This also could be a right answer, but it is not the BEST answer. When faced with a premeal low blood sugar, some people may choose to eat first then give their insulin afterward, based on glucose levels, but is this the preferred treatment strategy for RL?

Finally, Answer 4 is correct. 48.75% chose this answer, “Discuss which strategies would work best for RL in this situation.” YES, this is the BEST answer. RL may choose any of the above mentioned strategies, or RL may have some other ideas on how to manage this situation. Our goal is to keep it person centered and recognize the expertise of the individual who lives with diabetes everyday.


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