Chapter 35 (4)

Question 1

Type 2 diabetes is a complex disorder involving:

Answer 1

A suboptimal response of insulin-sensitive tissues in the liver

Question 2

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

Answer 2

Autoantibodies to two tyrosine phosphatases

Question 3

Diagnostic criteria for diabetes include:

Answer 3

Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl

Question 4

Routine screening of asymptomatic adults for diabetes is appropriate for:

Answer 4

Native Americans, African Americans, and Hispanics

Question 5

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

Answer 5

Any of the above

Question 6

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

Answer 6

Increasing peripheral glucose uptake by skeletal muscle and fat

Question 7

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:

Answer 7

He should increase his carbohydrate intake during times of exercise.

Question 8

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?

Answer 8

Glulisine

Question 9

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

Answer 9

Decreases glycogenolysis by the liver

Question 10

Before prescribing metformin, the provider should:

Answer 10

Draw a serum creatinine level to assess renal function.

Question 11

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:

Answer 11

Have a significant risk for hypoglycemia

Question 12

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

Answer 12

Low risk for hypoglycemia

Question 13

Control targets for patients with diabetes include:

Answer 13

Blood pressure less than 130/80 mm Hg

Question 14

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

Answer 14

Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl.

Question 15

Treatment with insulin for type 1 diabetics:

Answer 15

Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight

Question 16

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

Answer 16

Give two-thirds of the total dose in the morning and one-third in the evening.

Question 17

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:

Answer 17

Those with no significant cardiovascular disease

Question 18

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

Answer 18

Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease

Question 19

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

Answer 19

Metformin and insulin

Question 20

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:

Answer 20

Involuntary loss of 10% of body weight in less than 6 months

Question 21

The drugs recommended for older adults with type 2 diabetes include:

Answer 21

Third-generation sulfonylureas

Question 22

Ethnic groups differ in their risk for and presentation of diabetes. Hispanics:

Answer 22

Both 1 and 2
Have a high incidence of obesity, elevated triglycerides, and hypertension
Do best with drugs that foster weight loss, such as metformin

Question 23

The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk
for micro- and macro-vascular complications include:

Answer 23

Glycemic targets between 7% and 7.5%

Question 24

All diabetic patients with known cardiovascular disease should be treated with:

Answer 24

Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events

Question 25

All diabetic patients with hyperlipidemia should be treated with:

Answer 25

HMG-CoA reductase inhibitors

Question 26

Both angiotensin converting enzyme inhibitors and some angiotensin II receptor blockers have been approved in treating:

Answer 26

Both 1 and 2
Hypertension in diabetic patients
Diabetic nephropathy

Question 27

Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, and end stage renal disease in some patients with diabetes. It is useful for patients who:

Answer 27

Show progression of diabetic nephropathy despite optimal glucose and blood pressure control

Question 28

Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include:

Answer 28

Resting tachycardia, exercise intolerance, and orthostatic hypotension

Question 29

Drugs used to treat diabetic peripheral neuropathy include:

Answer 29

Gabapentin

Question 30

The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes?

Answer 30

HbA1C

Question 31

Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?

Answer 31

Check glucose level before, during, and after swimming.

Question 32

Allison is an 18-year-old college student with type 1 diabetes. Allison’s pre-meal 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?

Answer 32

Eat a granola bar or other snack with CHO.

Question 33

Bart is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, and hasn’t checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment?

Answer 33

Hyperglycemic hyperosmolar syndrome (HHS)

Question 34

What would one expected assessment finding be for hyperglycemic hyperosmolar syndrome?

Answer 34

Ketones in the urine

Question 35

A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication this morning and ate a bagel and coffee for breakfast. BP is 110/70 and random finger-stick glucose is 64. How should this patient be treated?

Answer 35

8 oz milk or 4 oz orange juice