Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the most appropriate glargine dose change for a man with fasting blood glucose at 210 mg/dL?

1. Decrease to 36 units.

2. Increase to 41 units.

3. Increase to 46 units.

4. Move glargine to morning at current dose.

The correct answer is: Increase to 46 units.

The most appropriate action in this scenario is to increase the glargine dose to 46 units for a man with a fasting blood glucose level of 210 mg/dL. Elevated fasting blood glucose levels indicate that current insulin therapy is insufficient to maintain glycemic control overnight. When determining how much to adjust insulin, a common approach is to make changes based on the degree of elevation in blood glucose levels. In a situation where fasting glucose is significantly above the target range, incrementing the insulin dose is a clinically appropriate response to improve glucose homeostasis. Dialing down the dose or maintaining the current dose, as mentioned in some options, would not address the elevated fasting blood glucose effectively and could lead to further hyperglycemia and associated risks. Therefore, increasing the glargine to 46 units is a logical decision to enhance insulin coverage, providing a better chance of achieving optimal fasting blood glucose levels in the future.