To address postprandial hyperglycemia in type 2 diabetes when using basal insulin, which adjustment is commonly considered?

• A. Adjusting basal insulin
• B. Changing the insulin type
• C. Adjusting the insulin-to-carbohydrate ratio (ICR)
• D. Reducing caloric intake only

Answer: (C)

Postprandial spikes when using basal insulin are addressed by how you cover meals with bolus insulin. Basal insulin sets the glucose level between meals and overnight, but the rise after eating comes from the carbohydrate in the meal and needs a mealtime insulin dose matched to that carb load. The insulin-to-carbohydrate ratio defines how many units of rapid-acting insulin you give for a given amount of carbohydrate. When post-meal glucose remains high, clinicians commonly increase this ratio so more insulin is provided per gram of carbohydrate, better matching the meal's glucose rise. This targeted adjustment to bolus insulin directly tackles the post-meal excursion, whereas changing the basal dose or insulin type mainly affects fasting control, and simply reducing calories doesn’t adjust the insulin-to-carb balance.