Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What approach would best stabilize blood glucose levels in a patient with an irregular meal schedule and elevated post-meal glucose?

1. Increase metformin

2. Add glargine insulin

3. Add saxagliptin

4. Add glipizide

The correct answer is: Add saxagliptin

In managing a patient with an irregular meal schedule and elevated post-meal glucose levels, the most effective approach is to add saxagliptin, a DPP-4 inhibitor. This medication works by enhancing the incretin system, which helps regulate insulin secretion in response to meals, ultimately assisting in controlling post-prandial (post-meal) glucose levels. It can help to increase insulin levels when necessary while also facilitating a decrease in glucagon levels, contributing to overall glucose homeostasis. Patients with an irregular meal schedule often experience variances in their blood glucose spikes, typically after eating. Saxagliptin is particularly advantageous in such scenarios as it has a relatively flexible dosing schedule and can effectively lower after-meal glucose spikes by promoting insulin secretion during meals. The choice of saxagliptin is beneficial in this context, as it complements the body’s natural responses to food intake without increasing the risk of hypoglycemia, which is a concern with other options that might intensify insulin production or action.