Aschool-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglyce- mia during practice. Which should the school nurse tell the child to do?

Eat twice the amount normally eaten at lunchtime.Take half the amount of prescribed insulin on practice days.Take the prescribed insulin at noontime rather than in the morning. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

Explanation.

Hypoglycemia is a blood glucose level less than 70 mg/dL (4 mmol/L) and results from too much insulin, not enough food, or excessive activity. An extra snack of 15 to 30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. A small box of raisins or a cup of orange juice provides 15 to 30 g of carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be doubled.