Question 1

Screening for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter:

Accepted Answer

All of the listed criteria are risk factors for developing type 2 diabetes in children. Children with a BMI above the 85th percentile for age and sex are at increased risk for developing diabetes due to insulin resistance caused by excess body fat. A family history of diabetes in a first- or second-degree relative is also a significant risk factor, indicating a genetic predisposition to the disease. Finally, hypertension, or high blood pressure, is associated with an increased risk of developing diabetes as well. Therefore, screening for all of these risk factors is important in identifying children who may be at risk for developing type 2 diabetes, allowing for early intervention and treatment to prevent or delay the onset of the disease.

Question 2

When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?

Accepted Answer

When the total daily insulin dose is split and given twice daily, a common rule followed is to give two-thirds of the total dose in the morning and one-third in the evening. This helps to provide adequate insulin coverage throughout the day and ensure blood sugar levels are well-managed.

Question 3

Before prescribing metformin, the provider should:

Accepted Answer

Before prescribing metformin, the provider should assess renal function by drawing a serum creatinine level. This is because metformin is primarily excreted by the kidneys, and its use is contraindicated in patients with impaired renal function. The other options, trying the patient on insulin or prescribing a thyroid preparation for weight loss, are not necessary or relevant for starting metformin.

Question 4

Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:

Accepted Answer

The answer of Dipeptidyl peptidase-4 inhibitors (gliptins) act on the...

Question 5

Control targets for patients with diabetes include:

Accepted Answer

Control targets for patients with diabetes include maintaining blood pressure less than 130/80 mm Hg. While targets for HbA1C, fasting blood glucose levels, and LDL lipids are also important, the blood pressure target is the only one listed among the choices provided.

Question 6

Insulin is used to treat both types of diabetes. It acts by:

Accepted Answer

Insulin helps to lower blood glucose levels by increasing peripheral glucose uptake by skeletal muscle and fat.

Question 7

Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes:

Accepted Answer

The answer of Establishing glycemic targets is the first step...

Question 8

Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:

Accepted Answer

Sulfonylureas have a significant risk for hypoglycemia, which is why they have been moved to Step 2 therapy.

Question 9

Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include:

Accepted Answer

DPatients with no significant cardiovascular disease and young children who are early in their disease are more likely to benefit from tighter glycemic control (HbA1C <7%) to prevent long-term complications of diabetes. Older adults and those with long-standing diabetes might have less stringent targets to avoid hypoglycemia and other risks.

Question 10

Routine screening of asymptomatic adults for diabetes is appropriate for:

Accepted Answer

According to the American Diabetes Association, routine screening of asymptomatic adults for diabetes is appropriate for individuals who are at increased risk, which includes Native Americans, African Americans, and Hispanics. Other risk factors for diabetes include being overweight or obese, having a family history of diabetes, having gestational diabetes or giving birth to a baby weighing more than 9 pounds, having high blood pressure or high cholesterol, and being physically inactive. Age alone is not a sufficient risk factor.

Question 11

Treatment with insulin for type 1 diabetics:

Accepted Answer

The starting total daily dose of insulin for type 1 diabetics is typically between 0.2 to 0.4 units per kg of body weight. This may be adjusted based on blood glucose levels and other factors, but this is the typical starting point.

Answer: B 
 For those with type 1 diabetes, dividing the total daily dose of insulin into three injections based on meal size is a typical treatment approach. This helps to mimic the way the body would naturally release insulin in response to meals, which helps to prevent blood glucose spikes.

Answer: C 
 While some type 1 diabetics may use a total daily dose of insulin glargine as part of their treatment, it is usually not the only insulin required. Insulin glargine is a long-acting basal insulin, which means it helps to maintain a baseline level of insulin in the body over a 24-hour period. However, mealtime insulin, such as rapid-acting or short-acting insulin, is also typically needed to cover meals and prevent blood glucose spikes.

Answer: D 
 While blood glucose levels are an important consideration in diabetes treatment, they are not the only factor considered. Other factors, such as body weight and lifestyle factors, are also taken into account when determining the appropriate insulin regimen for each individual with type 1 diabetes.

Question 12

Prevention of conversion from prediabetes to diabetes in young children must take highest priority and should focus on:

Accepted Answer

The answer of Prevention of conversion from prediabetes to diabetes...

Question 13

Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that:

Accepted Answer

When engaging in physical activity, the body uses glucose for energy, and this can cause low blood glucose levels in people with diabetes. Increasing carbohydrate intake before, during, and after exercise can help prevent hypoglycemia.

Question 14

Unlike most type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is:

Accepted Answer

Involuntary loss of 10% of body weight in less than 6 months is the most reliable indicator of poor nutritional status in older adults. This rapid weight loss is often a result of inadequate calorie and nutrient intake, and it can lead to a number of negative outcomes including increased morbidity and mortality. The other options may also be indicators of poor nutritional status, but they are not as reliable as the rapid and involuntary weight loss.

Question 15

Diagnostic criteria for diabetes include:

Accepted Answer

Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl is the diagnostic criteria for diabetes according to the American Diabetes Association. A fasting blood glucose between 100-125 mg/dl on two occasions indicates impaired fasting glucose, which is a pre-diabetic state but not diabetes. A fasting blood glucose greater than 140 mg/dl on two occasions and a postprandial blood glucose greater than 140 mg/dl are also indicators of diabetes, but not specific diagnostic criteria.

Question 16

Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action?

Accepted Answer

The answer of Insulin preparations are divided into categories based...

Question 17

The drug of choice for type 2 diabetics is metformin. Metformin:

Accepted Answer

Metformin decreases glucose production by the liver through a decrease in glycogenolysis and gluconeogenesis. It does not increase insulin release from the beta cells, increase intestinal uptake of glucose, or specifically prevent weight gain associated with hyperglycemia.

Question 18

Type 2 diabetes is a complex disorder involving:

Accepted Answer

Type 2 diabetes is primarily characterized by insulin resistance, meaning that the body's tissues do not respond adequately to insulin. While beta cell dysfunction and impaired glucagon-like peptide secretion may also play a role in the development of the disease, insulin resistance is the primary underlying factor. Intestinal fat uptake is also not a major contributor to the development of type 2 diabetes.

Question 19

The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:

Accepted Answer

Metformin is recommended for use in children with type 2 diabetes, while insulin is the primary medication for children with type 1 diabetes. Sulfonylureas and GPL-1 agonists are not recommended for use in children, and while split-mixed dose insulin is an option for some children with type 1 diabetes, it is not a first-line choice. Biguanides, specifically metformin, is the preferred oral medication for children with type 2 diabetes.

Question 20

Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have:

Accepted Answer

Autoantibodies to two tyrosine phosphatases, namely IA-2 (also known as ICA-512) and insulin, are present in 85-90% of individuals with type 1 diabetes. These autoantibodies indicate an autoimmune attack on the beta cells leading to destruction and subsequent insulin deficiency.

Quiz 33: Diabetes Mellitus