Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

When a patient with type 1 diabetes asks about sick day instructions regarding insulin use, what is the most appropriate explanation?

1. You should never take more insulin when not eating; instead, reduce it.

2. Extra basal insulin is needed because food is needed to fight illness.

3. During stress, the liver releases extra glucose; therefore, extra basal is necessary when sick.

4. Dehydration causes insulin to not absorb as well.

The correct answer is: During stress, the liver releases extra glucose; therefore, extra basal is necessary when sick.

When providing sick day instructions for a patient with type 1 diabetes, it is crucial to understand the physiological changes that occur during illness. When a person becomes ill, the body is under increased stress, which triggers the liver to release additional glucose into the bloodstream to provide energy for vital functions. This response is a protective mechanism, but it can lead to elevated blood glucose levels in individuals with diabetes. The recommendation for extra basal insulin during illness is based on this physiological response. By increasing basal insulin, the patient can better manage the elevated blood glucose levels resulting from the liver's increased glucose production. It is important for patients to understand that simply not eating does not negate the need for insulin; rather, their body may require more insulin to counteract the stress-induced hyperglycemia. In contrast, the other options do not adequately address the metabolic changes occurring during illness. It’s essential to provide clear and accurate information about insulin management during sick days, ensuring that patients can maintain stable blood glucose levels while navigating their illness. Such knowledge empowers patients to manage their diabetes effectively, even in challenging circumstances.