Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

For a patient with type 2 diabetes who frequently experiences low blood glucose after lunch, what is the most appropriate adjustment?

1. Lower the dose of repaglinide before lunch

2. Decrease the morning dose of metformin

3. Add a midafternoon snack

4. Reduce the afternoon metformin dose

The correct answer is: Lower the dose of repaglinide before lunch

In cases of recurrent low blood glucose levels after lunch in a patient with type 2 diabetes, adjusting the medication regimen is a critical evaluation. Repaglinide, a rapid-acting insulin secretagogue, increases insulin secretion in response to meals. If a patient consistently experiences hypoglycemia after lunch, it indicates that the dosage of this medication may be too high relative to the carbohydrate intake or insulin response during that meal. Lowering the dose of repaglinide before lunch directly addresses the cause of the low blood glucose by preventing excessive insulin from being released, thereby balancing the patient's blood glucose levels post-meal. This approach allows for better control without the risk of hypoglycemia, especially in patients whose carbohydrate consumption may vary throughout the day. Other options such as decreasing the morning dose of metformin or reducing the dose of afternoon metformin do not specifically target the post-lunch hypoglycemia. Metformin primarily works by decreasing hepatic glucose production and improves insulin sensitivity, and changes to its dosing may not have a significant immediate impact on postprandial blood glucose levels. Similarly, adding a midafternoon snack, while it may help to raise blood glucose levels, does not address the underlying issue of medication dosage that is leading to low blood glucose