American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary method to assess prandial insulin coverage in type 2 diabetes mellitus patients with high hemoglobin A1c levels?

1. Monitoring fasting blood glucose levels

2. Assessing dietary carbohydrate intake

3. Measuring postprandial blood glucose levels

4. Evaluating renal function tests

The correct answer is: Measuring postprandial blood glucose levels

Measuring postprandial blood glucose levels is the primary method to assess prandial insulin coverage in patients with type 2 diabetes mellitus who have elevated hemoglobin A1c levels. This approach focuses on understanding how well the patient's body manages blood glucose spikes that occur after meals. In individuals with diabetes, the post-meal rise in blood glucose is a critical indicator of how effectively insulin is working to counteract carbohydrate intake. If postprandial glucose levels remain high, it indicates that the current insulin regimen may not be adequate or that there might be issues with insulin sensitivity. Therefore, regularly measuring blood glucose levels after meals provides valuable insights into prandial insulin coverage, which can help clinicians tailor insulin dosing and improve overall glucose management. Other methods, while useful in diabetes management, do not provide direct insight into prandial insulin effectiveness. Monitoring fasting blood glucose levels primarily offers information about basal insulin needs rather than prandial coverage. Assessing dietary carbohydrate intake is important for dietary management but does not directly evaluate insulin effectiveness. Evaluating renal function tests, although crucial for overall health in diabetes patients, does not relate to the assessment of prandial insulin coverage specifically. Thus, utilizing postprandial blood glucose measurements allows for