Test Your Knowledge Issue 371

His correction factor is 1:50, which means that one unit of a fast acting insulin like Apidra, Novolog, or Humalog will lower his glucose level about 50 mg/dl.

His carbohydrateto-insulin ratio is 15 to 1, which means that for every 15 grams of carbohydrates consumed he will take one unit of Apidra. Mike’s blood glucose upon awaking was 72 mg/dl, and he ate breakfast at 8a.m. (60 grams of carbohydrates). He took 4 units of Apidra, calculated this way:

60 grams Carbohydrates in meal
÷ 15 grams/unit (Carbohydrate-to-insulin ratio)
= 4 units Meal dosage

At 9:20a.m. the high alert (set at 180 mg/dl and shown by the upper dashed lines in the graphs below) went off. Mike then did a fingerstick to confirm his glucose level. He then reviewed the 1-hour (figure a) and 3-hour (figure b) glucose trend graphs. Please review the graphs and then answer the following

Which of the option(s) below is the best suggestion for Mike to follow at 9:20a.m. when his high alert went off? (There may be more than one correct answer)

A. Watch and wait (give no additional insulin)

B. Walk for an hour at a brisk pace

C. Give a correction dose of 2 to 3 units

D. Adjust the carbohydrate-to-insulin ratio to 12:1 at breakfast if this scenario repeats itself every morning

For the correct answer, please click here.