Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

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For a patient taking metformin, what is the most appropriate change if their evening blood glucose is high?

Increase 8 am detemir to 20 units.
Increase 10 pm detemir to 20 units.
Move 6 pm metformin dose to 10 pm.
Add predinner (6 pm) aspart.

The correct answer is: Add predinner (6 pm) aspart.

Adding a predinner (6 pm) dose of aspart is a strategic approach for managing high evening blood glucose levels, especially for patients on metformin. This choice acknowledges the role of mealtime insulin in controlling postprandial (after meal) glucose spikes. Aspart is a rapid-acting insulin that starts working within minutes, making it effective for reducing the glucose derived from meals. By administering the aspart insulin prior to dinner, the patient can improve their body's ability to handle the glucose surge that typically occurs after eating, thereby addressing the high evening blood glucose readings directly tied to meal-related increases in blood sugar. Other options may not effectively target the cause of elevated evening glucose. Increasing detemir (a long-acting insulin) may not provide immediate relief for post-meal blood glucose spikes, while adjusting the timing of metformin does not directly address the need for immediate action during the dinner period.