Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the recommended adjustment for a patient with diabetes experiencing hypoglycemia at night?

1. Increase carbohydrate intake before bed.

2. Decrease glargine at bedtime.

3. Switch to a rapid-acting insulin.

4. Monitor glucose levels more frequently at night.

The correct answer is: Decrease glargine at bedtime.

When addressing a patient with diabetes who is experiencing hypoglycemia at night, the recommended adjustment is to decrease glargine at bedtime. Glargine is a long-acting insulin that helps maintain steady blood glucose levels throughout the night. If a patient is experiencing recurrent nighttime hypoglycemia, it indicates that the dosage may be too high for their current needs, leading to excess insulin action during the night when the patient is less active and has reduced ability to counteract low blood sugar levels. Adjusting the glargine dosage can prevent hypoglycemia episodes by lowering the baseline insulin levels available during the night. This helps stabilize the patient’s blood glucose levels, reducing the risk of nighttime hypoglycemia. The other options address potential changes in dietary and monitoring habits but do not directly remedy the underlying issue with insulin dosage that is contributing to hypoglycemia. Increasing carbohydrate intake, while it can help raise blood sugar levels during an episode, does not prevent future occurrences. Switching to rapid-acting insulin is typically not indicated for nocturnal management and would not address the persistent low blood sugar experienced overnight. Finally, increased monitoring can be helpful in tracking glucose levels but may not be a viable solution for preventing hypoglycemia if the underlying insulin dose is not