Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What adjustment should a patient make to prevent hypoglycemia during exercise when she typically experiences low blood glucose levels?

1. Consume a small amount of fat-free fruit before activity

2. Omit the breakfast dose of repaglinide on exercise days

3. Skip the morning dose of metformin on exercise days

4. Exercise will offer benefits, so weight concerns can be neglected

The correct answer is: Omit the breakfast dose of repaglinide on exercise days

To effectively prevent hypoglycemia during exercise, adjusting the timing and dosage of certain medications is crucial. Omitting the breakfast dose of repaglinide on exercise days is a reasonable strategy, particularly because repaglinide is a rapid-acting insulin secretagogue. The medication works by stimulating the pancreas to release insulin, which can lead to lower blood glucose levels. When exercising, particularly if this patient already tends to experience low blood glucose levels, skipping the morning dose can help avoid an additive effect that could lead to hypoglycemia during or after exercise. In contrast, consuming a small amount of fat-free fruit may not adequately address the risk of hypoglycemia as it doesn't influence the insulin levels in the same way that adjusting medication can. Additionally, metformin typically does not lead to hypoglycemia on its own but rather helps with glucose management, making it less relevant to skip on exercise days. The statement about neglecting weight concerns due to exercise does not address the need to manage medications effectively to prevent hypoglycemia during activity. Thus, the most appropriate and direct adjustment to prevent hypoglycemia for this patient involves modifying the dosage of repaglinide.