What is the purpose of corrections around meals in postprandial management?

• A. To stabilize liver glycogen stores.
• B. To adjust basal insulin dosing.
• C. To avoid hypoglycemia at night.
• D. To adjust prandial insulin dosing based on carbohydrate intake and glucose targets around meals.

Answer: (D)

Corrections around meals are used to fine-tune the prandial insulin dose by accounting for both how much carbohydrate you plan to eat and what your glucose level is before the meal. The bolus dose is typically the sum of two parts: the carbohydrate portion (carbs divided by your carb-to-insulin ratio) and a correction portion (extra insulin to bring a high pre-meal glucose down to target, based on your correction factor). This approach aims to keep postmeal glucose within the target range, preventing postprandial hyperglycemia. It’s not about changing basal insulin, which is the background dose between meals, and while avoiding nocturnal hypoglycemia is important, the primary purpose of meal-time corrections is to align postmeal glucose with target levels. For example, if you’re eating a meal with 60 g of carbs and your carb ratio is 1:10, you’d cover 6 units for the carbs; if your premeal glucose is above target (say 180 mg/dL) and your correction factor is 1 unit per 50 mg/dL, you’d add about 1.5–2 units to bring it down toward target, totaling a bolus that better matches the postmeal need.