Allison is an 18-year-old college student with type 1 diabetes. Allison's premeal blood glucose (BG) at 11:30 a.m. is 130. She eats an apple and has a sugar-free soft drink. At 1 p.m. before swimming her BG is 80. What should she do?

Rationale: A. Proceeding with an aerobic activity like swimming when the blood glucose is already at a borderline low of 80 mg/dL is dangerous. Exercise increases glucose uptake by the skeletal muscles via insulin-independent pathways, which can cause a rapid decline in blood sugar. Without intervention, Allison is at high risk for symptomatic hypoglycemia, which can lead to impaired coordination and loss of consciousness while in the water. B. Taking an additional dose of insulin would be contraindicated as it would further lower her blood glucose levels. Insulin facilitates the transport of glucose into the cells, effectively removing it from the bloodstream. Since her level is already approaching a hypoglycemic state, adding exogenous insulin would accelerate the drop in glucose and likely precipitate a medical emergency during her physical activity. C. Rechecking the blood glucose immediately provides redundant information without addressing the physiological need for fuel. Her current reading of 80 mg/dL combined with the plan for vigorous exercise provides enough clinical data to warrant immediate preventative action. While monitoring is important, the priority must be to stabilize her blood sugar before it drops into a range that compromises her safety and cognitive function. D. Allison should consume a snack containing 15 to 30 grams of carbohydrates, such as a granola bar, to provide a sustained source of energy for her swim. This intervention follows the clinical guidelines for managing diabetes during exercise to prevent exercise-induced hypoglycemia. The complex carbohydrates in a bar will provide a slower, more stable release of glucose into the blood compared to simple sugars alone.