A 55-year-old client with type 2 diabetes is on a basal-bolus insulin regimen (glargine once daily and lispro insulin before meals). Over the past week, their fasting glucose levels are consistently at target, but glucose levels remain elevated after lunch and dinner. Which of the following is the most appropriate adjustment to improve glycemic control?

Rationale: A. Add an additional dose of basal insulin in the afternoon: Basal insulin is intended to provide a steady background insulin level to control fasting and between-meal glucose. Adding an extra dose can increase the risk of hypoglycemia without specifically targeting postprandial hyperglycemia, so it is not the most appropriate approach for elevated post-lunch and dinner glucose. B. Increase the dose of basal insulin: Increasing basal insulin primarily lowers fasting and pre-meal glucose by maintaining background insulin levels. Since the client’s fasting glucose is already at target, increasing basal insulin may lead to hypoglycemia during the night or between meals, without adequately addressing postprandial spikes. C. Shift the basal insulin timing to bedtime: Changing the timing of basal insulin may slightly alter overnight glucose control, but it does not significantly impact postprandial hyperglycemia after lunch and dinner. Timing adjustments alone are unlikely to correct elevated post-meal glucose levels. D. Increase the bolus doses of insulin: Bolus insulin, such as lispro, is rapid-acting and administered before meals to control postprandial glucose excursions. Increasing the pre-lunch and pre-dinner bolus doses addresses the specific elevations after those meals, improving overall glycemic control while maintaining target fasting levels.