Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

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For a patient with type 1 diabetes using an insulin pump, what would be the most accurate bolus dose for a meal containing 42 grams of carbohydrate?

3.5 units
4.0 units
4.5 units
5.0 units

The correct answer is: 4.5 units

To determine the most accurate bolus dose for a meal containing 42 grams of carbohydrates for a patient with type 1 diabetes using an insulin pump, it's essential to understand carbohydrate counting and insulin-to-carbohydrate ratios. Typically, patients with type 1 diabetes calculate their insulin doses based on an established insulin-to-carbohydrate ratio. For example, if the ratio is 1 unit of insulin for every 10 grams of carbohydrates, then for a meal containing 42 grams of carbohydrates, the calculation would be 42 grams divided by 10, resulting in approximately 4.2 units. In this scenario, having the bolus dose as 4.5 units would be a more precise amount to administer based on this typical calculation. It takes into account the need to provide slight adjustments for variations in glycemic response after meals and finer precision in the overall management of blood glucose levels. Thus, rounding up to 4.5 units serves to cover the carbohydrate intake effectively while ensuring adequate glycemic control post-meal. Choosing 4.0 or 5.0 units may either underdose or overdose the bolus, leading to suboptimal post-meal glucose levels. Similarly, a bolus of 3.5 units would not sufficiently