A 17-Year-Old Boy Comes to the Office Before Participating in Long-Distance

A 17-year-old boy comes to the office before participating in long-distance running.  The patient has a 2-year history of type 1 diabetes mellitus and takes insulin glargine at bedtime and insulin lispro before meals.  His home blood glucose levels range from 90 to 130 mg/dL, and he has had no episodes of hypoglycemia.  The patient wants to run a marathon and has begun training recently.  Physical examination is normal.  Hemoglobin A1c is 6.5%.  Which of the following is the most appropriate recommendation to manage his diabetes mellitus during long-distance training?

A) Consume high-protein bars before running
B) Limit running to 30-minute training sessions
C) Reduce dosage of basal and bolus insulins
D) Stop glargine and continue lispro as sliding scale
E) Test urine ketones before and after exercise

Correct Answer:

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