Diabetes Flashcards
- A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than normal and has lost approximately 20 pounds (9.1 kg) in the past 6 months without trying. His random glucose today is 252 mg/dL (14.0 mmol/L). Which of the following is most appropriate to confirm diagnosis of type 2 diabetes?
A. Obtain a fasting glucose level in the morning.
B. Have patient perform a 2-hour oral glucose tolerance test.
C. Obtain patient’s hemoglobin A1c.
D. Obtain a repeat random glucose level.
E. Nothing; there is enough information available to diagnose patient with type 2 diabetes.
E
- A 36-year-old Caucasian woman is concerned about her risks for developing type 2 diabetes because her mother and father have the disease. Currently, she weighs 145 lbs (66 kg; BMI = 22 kg/m2) and has no other medical conditions. All of her children weighed less than 8 lbs (3.6 kg) at birth and she is preparing for her second marathon. The most appropriate recommendation for screening is to begin:
A. At the age of 45 then every 3 years if normal.
B. At the age of 45 then every year if normal.
C. At the age of 40 then every 3 years if normal.
D. At the age of 40 then every year if normal.
E. As soon as possible then every year if normal.
A
Questions 3–5 refer to the following case:
A 67-year-old Caucasian woman has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vitals and labs were as follows: BP 157/94 mm Hg, Wt 157 lbs (71 kg; BMI = 24 kg/m2), A1c 8.7% (0.087; 72 mmol/mol Hgb), FPG 174 mg/dL (9.7 mmol/L), LDL 52 mg/dL (1.34 mmol/L), HDL 59 mg/dL (1.53 mmol/L), TG 45 mg/dL (0.51 mmol/L).
- Which of the following is the most appropriate recommendation for therapy according to the ADA algorithm?
A. Lifestyle changes only
B. Metformin only
C. Intensive insulin only
D. Lifestyle changes and metformin
E. Lifestyle changes and intensive insulin
Diabetes Mellitus 2
D
Questions 3–5 refer to the following case:
A 67-year-old Caucasian woman has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vitals and labs were as follows: BP 157/94 mm Hg, Wt 157 lbs (71 kg; BMI = 24 kg/m2), A1c 8.7% (0.087; 72 mmol/mol Hgb), FPG 174 mg/dL (9.7 mmol/L), LDL 52 mg/dL (1.34 mmol/L), HDL 59 mg/dL (1.53 mmol/L), TG 45 mg/dL (0.51 mmol/L).
- What is the patient’s goal blood pressure according to current ADA treatment guidelines?
A. Less than 125/80
B. Less than 130/80
C. Less than 135/85
D. Less than 140/90
E.Less than 150/90
D
Questions 3–5 refer to the following case:
A 67-year-old Caucasian woman has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vitals and labs were as follows: BP 157/94 mm Hg, Wt 157 lbs (71 kg; BMI = 24 kg/m2), A1c 8.7% (0.087; 72 mmol/mol Hgb), FPG 174 mg/dL (9.7 mmol/L), LDL 52 mg/dL (1.34 mmol/L), HDL 59 mg/dL (1.53 mmol/L), TG 45 mg/dL (0.51 mmol/L).
- What is the most appropriate medication to add to the patient’s regimen to control her hypertension?
A. Amlodipine
B. Clonidine
C. Lisinopril
D. Metoprolol
E. Verapamil
C
- Which of the following statements regarding nonpharmacologic therapy for treatment of diabetes is true?
A. Individualized meal plans should be developed for people with diabetes based on cultural preferences, comorbidities, and daily schedule as much as possible.
B. Current clinical evidence supports the use of dietary supplements such as chromium in the management of diabetes.
C. Weight loss works best for patients with type 1 diabetes since most are overweight.
D. Long-term goals for physical activity should include at least 30 minutes of aerobic exercise once a week for all patients with diabetes.
E. Influenza vaccinations are recommended for all patients with diabetes every 5 years.
A
- A 12-year-old boy is newly diagnosed with type 1 diabetes. His current height is 60 in (152cm) and he weighs 40 kg (88 lb). What dose of basal insulin should be initiated for him?
A. 12 units insulin glargine
B. 6 units insulin lispro
C. 4 units insulin detemir
D. 3 units insulin aspart
E. 2 units insulin glulisine
A
- Oral glucose lowering agents that primarily inhibit the breakdown of glucagon-like peptide 1 are classified as:
A. Sulfonylureas
B. SGLT2 inhibitors
C. DPP-4 inhibitors
D. Meglitinides
E. Thiazolidinediones
C
- A 32-year-old woman is diagnosed with gestational diabetes after being administered an oral glucose tolerance test during her 28th-week of gestation. She has not been able to reduce or control her glucose readings with lifestyle interventions alone and her physician wants to start pharmacotherapy. Which agent below is the preferred medication, considering her glucose readings are significantly elevated?
A. Glyburide
B. Insulin glargine
C. NPH insulin
D. Liraglutide
E. Metformin
C
- A 59-year-old Asian American woman has a 3-year history of T2DM. She presents with no new complaints today. Her labs and vitals are: A1c 8.1% (0.081; 65 mmol/mol Hgb), FBG 320mg/dL (17.8 mmol/L), LDL 118 mg/dL (3.05 mmol/L), HDL 32 mg/dL (0.83 mmol/L), TG 325
mg/dL (3.67 mmol/L), SCr 1.9 mg/dL (168 μmol/L), BP 128/78 mm Hg, HR 68 beats/min, Wt 135 lb (61.4 kg), Ht 5’2” (157 cm). Her current medications are:
Glimepiride 2 mg once daily
Metformin 1000 mg twice daily
Exenatide 10 mcg twice daily
Sitagliptin 50 mg daily
Alendronate 70 mg/week
Simvastatin 20 mg once daily
Paroxetine 20 mg once daily
Aspirin 81 mg once daily
Which of her medications should be discontinued and for what reason?
A. Glimepiride—may increase risk of heart failure
B. Metformin—due to renal dysfunction
C. Exenatide—may cause weight gain
D. Sitagliptin—may increase nausea and vomiting
E. None of her medications should be discontinued
B
- A 38-year-old man with type 1 diabetes presents requesting help with his insulin
management. He needs to update his insulin to carbohydrate ratio in order to accurately dose his bolus insulin at meals. Which rule below should he use to calculate his insulin to carbohydrate
ratio given that he administers insulin lispro in his pump?
A. Rule of 450
B. Rule of 500
C. Rule of 1500
D. Rule of 1800
Diabetes Mellitus 4
E. Rule of 2000
B
- A 17-year-old female patient with type 1 diabetes currently uses a total of 40 units of insulin aspart daily in her pump. What is the expected reduction in glucose per unit of insulin for her?
A. 12.5 mg/dL (0.7 mmol/L)
B. 30 mg/dL (1.7 mmol/L)
C. 37.5 mg/dL (2.1 mmol/L)
D. 45 mg/dL (2.5 mmol/L)
E. 50 mg/dL (2.8 mmol/L)
D
- Select the oral medication from the list below that is most likely to result in weight loss for patients with diabetes.
A. Dapagliflozin
B. Glyburide
C. Liraglutide
D. Pioglitazone
E. Sitagliptin
A
- A 57-year-old man has had type 2 diabetes for approximately 15 years. His physician is initiating insulin therapy today due to his elevated A1c despite oral therapy. Which of the following is the most appropriate option?
A. Initiate insulin glargine 10 units every night at bedtime
B. Initiate insulin lispro 10 units every night at bedtime
C. Initiate insulin aspart 10 units every morning
D. Initiate insulin glulisine 10 units twice daily
E. Initiate 70% insulin aspart protamine/30% insulin aspart 10 units every night at bedtime
A
- All of the following are true regarding noninsulin injectable therapy for treatment of diabetes, except:
A. Albiglutide is administered once weekly.
B. Exenatide lowers glucose levels by several mechanisms including regulating gastric emptying.
C. Liraglutide and albiglutide are administered without regard to meals.
D. Pramlintide is approved for use in patients with type 1 and 2 diabetes currently using insulin
E. Pramlintide is as effective as insulin at lowering A1C levels in patients with type 1 diabetes.
E
- Which of the following statements regarding immunizations in patients with diabetes is true?
A. Hepatitis A vaccination with either a two- or three-dose regimen is recommended for all patients with diabetes aged 60 years and older.
B. Influenza vaccinations are recommended for all patients with diabetes every 5 years.
C. Pneumococcal conjugate vaccination is recommended for all patients with diabetes aged 65 years and older.
D. Pneumococcal polysaccharide vaccination is recommended once between ages 19 and 64 years then again after age 65.
D
Option D: Correct. Pneumococcal polysaccharide vaccination is recommended in all patients
with diabetes between ages 19 and 64 years. Once the patient turns 65, they should receive a second dose of pneumococcal polysaccharide vaccination. If the patient and their provider should decide on the patient receiving the pneumococcal conjugate vaccine at age 65, the polysaccharide vaccine should be given 1 year later.
- A 12-year-old boy is newly diagnosed with type 1 diabetes. His current height is 60 in. (152 cm) and he weighs 40 kg (88 lb). What dose of basal insulin should be initiated for him?
A. 12 units insulin glargine
B. 6 units insulin lispro
C. 4 units insulin detemir
D. 3 units insulin aspart
A
Option A: Correct. A recommended starting dose for insulin in a patient with T1DM is 0.4 to 1 units/kg/day. For this patient, that would be approximately 24 to 40 units per day total. Basal insulin should make up 50% of this dose, or 12 to 20 units, with the remainder being split between mealtime rapid acting insulin doses. Option A represents a correct starting basal insulin
dose for this patient at 12 units of insulin glargine.
- Which of the following oral glucose lowering agents is most likely to cause hypoglycemia?
A. Acarbose
B. Glyburide
C. Nateglinide
D. Saxagliptin
B
- Which of the following antihyperglycemic agents can cause hypotension due to osmotic diuresis?
A. Alogliptin
B. Canagliflozin
C. Glimepiride
D. Miglitol
B
- A 54-year-old Asian American female has a 3-year history of T2DM. Two weeks ago at her quarterly office visit, semaglutide injectable was added to her metformin. Her labs and vitals were A 1c 8.1% (0.081; 65 mmol/mol Hgb), FBG 320 mg/dL (17.8 mmol/L), LDL cholesterol 118 mg/dL (3.05 mmol/L), HDL cholesterol 32 mg/dL (0.83 mmol/L), triglycerides 325 mg/dL (3.67 mmol/L), SCr 1.4 mg/dL (124 µmol/L), BP 128/78 mm Hg, HR 68 beats/min, Wt 135 lb (61.2 kg), Ht 5′2″ (157 cm). Her current medications are now:
A. Metformin 1000 mg twice daily
B. Semaglutide 0.25 mg SC once weekly
C. Atorvastatin 20 mg once daily
D. Paroxetine 20 mg once daily
Which of her medications should be dose-adjusted?
A. Metformin
B. Semaglutide
C. Atorvastatin
D. Paroxetine
A
- Pancreatitis is a possible severe adverse effect that could occur with which of the following antihyperglycemic agents?
A. Exenatide
B. Glimepiride
C. Metformin
D. Pioglitazone
A
- A 21-year-old female patient with type 1 diabetes currently uses a total of 50 units of insulin aspart daily in her pump. What is the expected reduction in glucose per unit of insulin for her?
A. 20 mg/dL (1.1 mmol/L)
B. 33 mg/dL (1.8 mmol/L)
C. 45 mg/dL (2.5 mmol/L)
D. 66 mg/dL (3.7 mmol/L)
B
- Select the medication from the list below that is most likely to result in weight gain for patients with diabetes.
A. Dapagliflozin
B. Metformin
C. Pioglitazone
D. Sitagliptin
C
- A 57-year-old man has had type 2 diabetes for approximately 15 years. His provider is initiating insulin therapy today due to his elevated A 1c despite oral therapy. Which of the following is the most appropriate option?
A. Initiate insulin glargine 10 units every night at bedtime
B. Initiate insulin lispro 10 units every night at bedtime
C. Initiate NPH insulin 10 units every night at bedtime
D. Initiate 70% insulin aspart protamine/30% insulin aspart 10 units every night at bedtime
A
- Which of the following regarding GLP-1 agonists is true?
A. Exenatide extended-release is administered twice daily like the immediate release product.
B. The dose for semaglutide injectable may be increased on a weekly basis.
C. The most common side effect for GLP-1 agonists is hypoglycemia.
D. GLP-1 agonists should be initiated prior to prandial insulin if not already prescribed.
D
- A 46-year-old man presents for his annual physical with no new chief complaint. His random glucose today is 252 mg/dL (14.0 mmol/L). Which of the following represents the most
appropriate method for confirming diagnosis of type 2 diabetes in this patient during today’s visit?
A. Have patient perform a 2-hour oral glucose tolerance test.
B. Obtain a fasting glucose level.
C. Obtain patient’s hemoglobin A 1c .
D. There is no need to conduct further testing; a single random sample is adequate for diagnosis.
C
- Which of the following is correct regarding ADA recommendations for screening for asymptomatic T2DM?
A. All adults, beginning at age 40, should be screened every 3 years.
B. All adults, beginning at age 45, should be screened every 3 years.
C. All adults, beginning at age 45, should be screened every 5 years.
D. All adults, beginning at age 50, should be screened every 5 years.
B
A 67-year-old woman was diagnosed with type 2 diabetes 5 years ago. She has been adequately treated with metformin 1 g twice daily during that time. Her past medical history is significant for hypertension, dyslipidemia, hypothyroidism, and reduced ejection fraction heart failure, NYHA class II today. She has no history of tobacco use. Her medications include metformin, valsartan, rosuvastatin, furosemide, carvedilol, and levothyroxine. Her vitals and labs are as
follows: BP 142/86 mm Hg, HR 72 bpm, Wt 168 lb (76.2 kg), Ht 5 3 (160 cm; BMI = 29.8 kg/m 2 ), A 1c 8.2% (0.082; 66 mmol/mol Hgb), FPG 174 mg/dL (9.7mmol/L), total cholesterol 180 mg/dL (4.65 mmol/L), LDL cholesterol 80 mg/dL (2.07 mmol/L), HDL cholesterol 59 mg/dL (1.53 mmol/L), triglycerides 205 mg/dL (2.32 mmol/L), ALT 18 U/L (0.3 µkat/L), albumin-to-creatinine ratio 45 mg/g (5.1 mg/mmol), SCr 1.1 mg/dL (97 µmol/L), eGFR 52.7 mL/min/1.73 m 2 .
- Which of the following is the most appropriate recommendation for additional therapy in this patient according to the ADA algorithm?
A. Insulin degludec
B. Dapagliflozin
C. Saxagliptin
D. Pioglitazone
B
A 67-year-old woman was diagnosed with type 2 diabetes 5 years ago. She has been adequately treated with metformin 1 g twice daily during that time. Her past medical history is significant for hypertension, dyslipidemia, hypothyroidism, and reduced ejection fraction heart failure, NYHA class II today. She has no history of tobacco use. Her medications include metformin, valsartan, rosuvastatin, furosemide, carvedilol, and levothyroxine. Her vitals and labs are as
follows: BP 142/86 mm Hg, HR 72 bpm, Wt 168 lb (76.2 kg), Ht 5 3 (160 cm; BMI = 29.8 kg/m 2 ), A 1c 8.2% (0.082; 66 mmol/mol Hgb), FPG 174 mg/dL (9.7 mmol/L), total cholesterol 180 mg/dL (4.65 mmol/L), LDL cholesterol 80 mg/dL (2.07 mmol/L), HDL cholesterol 59 mg/dL (1.53 mmol/L), triglycerides 205 mg/dL (2.32 mmol/L), ALT 18 U/L (0.3 µkat/L), albumin-to-creatinine ratio 45 mg/g (5.1 mg/mmol), SCr 1.1 mg/dL (97 µmol/L), eGFR 52.7
mL/min/1.73 m 2 .
- What is the patient’s goal blood pressure according to current ADA treatment guidelines?
A. Less than 120/80
B. Less than 130/80
C. Less than 140/90
D. Less than 150/90
B
A 67-year-old woman was diagnosed with type 2 diabetes 5 years ago. She has been adequately treated with metformin 1 g twice daily during that time. Her past medical history is significant for hypertension, dyslipidemia, hypothyroidism, and reduced ejection fraction heart failure, NYHA class II today. She has no history of tobacco use. Her medications include metformin, valsartan, rosuvastatin, furosemide, carvedilol, and levothyroxine. Her vitals and labs are as
follows: BP 142/86 mm Hg, HR 72 bpm, Wt 168 lb (76.2 kg), Ht 5 3 (160 cm; BMI = 29.8 kg/m 2 ), A 1c 8.2% (0.082; 66 mmol/mol Hgb), FPG 174 mg/dL (9.7 mmol/L), total cholesterol 180 mg/dL (4.65 mmol/L), LDL cholesterol 80 mg/dL (2.07 mmol/L), HDL cholesterol 59 mg/dL (1.53 mmol/L), triglycerides 205 mg/dL (2.32 mmol/L), ALT 18 U/L (0.3 µkat/L), albumin-to-creatinine ratio 45 mg/g (5.1 mg/mmol), SCr 1.1 mg/dL (97 µmol/L), eGFR 52.7
mL/min/1.73 m 2 .
- After discussing the potential risks and benefits of aspirin therapy for primary prevention, which of the following would be the most appropriate recommendation for aspirin therapy in this patient?
A. None
B. 81 mg daily
C. 325 mg daily
D. 650 mg daily
B
