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 intermediate-acting insulin that 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. Note the NPH insulin dosage change would need to be performed by a physician with the ability to prescribe the change. The CNS should advise the patient to seek counsel from the prescribing physician on lowering the morning dosage.
