Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

For a patient with type 2 diabetes experiencing fluctuating fasting glucose levels, what is the most appropriate recommendation?

1. Reduce lispro at meals.

2. Decrease glargine at bedtime.

3. Increase glargine at bedtime.

4. Increase lispro at meals.

The correct answer is: Decrease glargine at bedtime.

In managing a patient with type 2 diabetes who is experiencing fluctuating fasting glucose levels, it is essential to analyze how basal insulin affects fasting blood sugar. Glargine, a long-acting insulin, is designed to provide consistent background insulin levels throughout the day and night. If a patient is experiencing high fasting glucose levels, this often indicates that the basal insulin is inadequate or needs to be adjusted. Increasing glargine at bedtime can help provide the body with more consistent insulin coverage overnight, thus potentially lowering fasting blood glucose levels by ensuring that there is sufficient insulin to counteract hepatic glucose production during the night. This adjustment would address the specific issue of fluctuations occurring primarily in the fasting state. In contrast, reducing or adjusting the dosage of lispro, a rapid-acting insulin, does not directly impact fasting glucose levels since it primarily works to manage glucose spikes after meals. Hence, any alteration in its dosage is unlikely to stabilize fasting glucose levels.