Deck 54: Diabetes Mellitus

Question 1

For a patient with acute-onset neuropathy following marked hyperglycemia, return to glycemic control can reverse symptoms.

Answer 1

True

Question 2

Which of the following sulfonylureas is on the Beers Criteria and to be avoided among elderly patients.

A) Glyburide due to its prolonged half -life and higher risk of prolonged hypoglycemia.
B) Glipizide due to its prolonged half-life and higher risk of prolonged hypoglycemia.
C) Neither one; they are both appropriate for elderly patients.
D) All sulfonylureas are to be avoided in elderly patients.

Answer 2

A

Question 3

At which level of renal impairment should a clinician discontinue the use of metformin?

A) Glomerular filtration rate (GFR) < 60 ml/min
B) GFR < 40 ml/min
C) GFR < 30 ml/min
D) None of the above; it can be used regardless of kidney function

Answer 3

C

Question 4

A patient reports she is having symptoms of hypoglycemia at 11am at least three times a week. She reports skipping breakfast and taking her glipizide 10 mg at 7am with water. She also takes metformin 1,000 mg twice daily and glargine 23 units at bedtime. Patient weighs 90 kg and has had diabetes for 10 years. You explain that:

A) Her symptoms of hypoglycemia are likely due to her glargine and taking metformin at the same time.
B) Her symptoms of hypoglycemia are likely due to her lack of food intake in the morning (breakfast) and the timing of her glipizide.
C) Her hypoglycemia is not related to her medication regimen or eating patterns.
D) Her hypoglycemia is likely to due to high-dose metformin and her lack of food.

Question 5

Match the laboratory studies and referrals to the correct frequency for people with type 2 diabetes.
Every visit

A) Ophthalmology referral
B) Lipid panel
C) Foot exam for patients with sensory deficiencies or foot deformities or history of ulcers
D) Urine albumin-to-creatinine ratio (UACR)

Question 6

Match the laboratory studies and referrals to the correct frequency for people with type 2 diabetes.
At diagnosis

A) Ophthalmology referral
B) Lipid panel
C) Foot exam for patients with sensory deficiencies or foot deformities or history of ulcers
D) Urine albumin-to-creatinine ratio (UACR)

Question 7

Match the laboratory studies and referrals to the correct frequency for people with type 2 diabetes.
At least once a year

A) Ophthalmology referral
B) Lipid panel
C) Foot exam for patients with sensory deficiencies or foot deformities or history of ulcers
D) Urine albumin-to-creatinine ratio (UACR)

Question 8

All of the following are criteria that one can use to diagnosis diabetes except:

A) HbA1c of 6.8% done with a point of care test at a local health fair
B) A random blood glucose of 200 with classic symptoms of diabetes
C) A 2-h plasma glucose of >/= to 200 mg/d during an OGTT
D) HbA1c of 6.6% drawn as part of an annual physical exam

Question 9

Ms. Jones is a 55-year-old patient with new onset diabetes for 3 months and long-standing hypothyroidism that is treated with 75 mcg of levothyroxine QD. Her HbA1c at diagnosis was 7.8% and she began metformin and has titrated it to 1,000 mg twice daily. She has no family history of type 2 diabetes. Her presenting BMI is 20. She is complaining of starving herself and noting that her fasting blood glucose still runs high (120-190mg/dl). Your next step is:

A) Add a sulfonylurea such as glimepiride
B) Order an insulin and c-peptide level
C) Order auto-antibodies (Anti-GAD 65, ICA-512)
D) Ask her to exercise in the evening to help her fasting blood glucose

Question 10

A 45-year-old obese female patient with type 2 diabetes mellitus for 10 years has had a recent severe exacerbation in her asthma and has been put on a daily dose of prednisone 10 mg. She takes 1,000 mg twice a day of metformin and glimepiride 6 mg daily. Her fasting BG average has increased by 70mg/dl. Her previous fasting blood glucose average was 120 and is now 190 mg/dl. The most appropriate action would be:

A) Stop the prednisone
B) Increase her metformin by 1,000 mg
C) Initiate insulin therapy
D) Recheck her HbA1c at her follow-up visit in 3 months

Question 11

Mr. Smith is a 68-year-old male who has had type 2 diabetes for 15 years and has been managed on oral hypoglycemic agents. He weighs 90 kg. Over the past year, his HbA1c has steadily climbed and is now 9.2%. Which of the following insulin regimens would be the most appropriate to start in this case?

A) Basal/bolus regimen of 45 units of glargine at bedtime and 15 units of aspart before meals.
B) 10-18 units of glargine (Lantus)daily at time most convenient for patients
C) Rapid acting insulin (RAI) before each meal
D) Twice daily NPH, 30 units before breakfast and 15 units before supper

Question 12

A 50-year-old male patient has a 15-year history of diabetes. The patient injects 24 units of NPH and 12 units of insulin lispro before breakfast and 12 units of NPH and 6 units of insulin lispro before dinner. The patient's glucose pattern is as follows: Fasting blood glucose Average is 110 and prelunch average is 220 mg/dl ; predinner average is 180 mg/dl; and bedtime BG average is 140. The dose adjustment that best addresses this glucose profile is:

A) Adding 2 units of lispro before breakfast
B) Adding 4 units of lispro before dinner
C) Adding 2 units of lispro before lunch
D) Decreasing evening NPH by 2 units