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CNS Nutrition Specialist Exam Prep

Category - CBNS

A 16-year old teenage girl with Type I diabetes seeks counseling for erratic blood glucose levels. She is on the school track team and works out in the afternoons for 1 ½ hours. Her meal plan consists of 3 meals, a pre-exercise snack of one fruit, and a bedtime snack of ½ cup cereal and 1 cup of milk. Her insulin regimen is 3 units of regular insulin before breakfast and 2 units of regular insulin before dinner, and equal amounts of NPH mid-morning and at bedtime. Lately her pre-dinner blood glucose levels have been low. What would be the most effective nutrition intervention for her?

  1. Reduce the mid-morning NPH insulin by one unit and add a protein exchange to the afternoon snack.
  2. Increase the bedtime insulin and add another bread exchange to the bedtime snack.
  3. Reduce the afternoon exercise to 45 minutes and have her carry fruit juice with her in case she feels dizzy or weak.
  4. A & B
Answer and Explanation

Your answer: -
Answer: A - The most effective intervention would be to reduce the mid-morning NPH insulin by one unit and add protein exchange to the afternoon snack. NPH is an intermediate-acting insulin which has its peak effect in the afternoon. Reducing the amount of NPH by one unit and adding protein to the pre-exercise snack will help eliminate low blood glucose levels before the evening meal.