Diabetes Mellitus (Therapeutics)

Question 1

Which of the following statements is true?

A. Goal of fasting glucose is 70-130 mg/dL
B. Goal of HgA1c is individualized, but in general should be

Answer 1

(D) A & B only are true

C - Goal BP for a diabetic patient is 140/80, not 140/90

Question 2

All of the following statements are true, except?

A. If you are screening a patient for diabetes, that patient is asymptomatic
B. You should perform a foot exam at every diabetes visit
C. The LDL goal for a diabetic who had an MI would be

Answer 2

(C) The LDL goal for a diabetic patient who had an MI would be

Question 3

How often should you perform a HgA1c test for a diabetic patient?

Answer 3

every 3-6 months

Question 4

What is the goal lipid profile for a diabetic patient (LDL, TG, HDL)?

Answer 4

LDL < 100
TG < 150
HDL > 50

Question 5

All of the following statements are true, except?

A. Diet and exercise is a therapy and Tx for diabetes
B. Nearly all carbohydrates enter the bloodstream as glucose
C. Sucrose does not increase hyperglycemia to a great extent
D. It is not necessary for a diabetic to inspect their feet after every time they exercise
E. Diabetic patients should get 30 min of exercise 3-4 times per week if they’re able

Answer 5

(D) - It IS NECESSARY for a diabetic to inspect their feet after every time they exercise

C - this is a correct statement according to DM therapeutic lecture -slide #3

Question 6

Give the brand name of the following insulins and categorize it as rapid, short, or long acting:

Glargine
Glulisine
Regular
NPH
Detemir
Lispro
Aspart

Answer 6

Glargine (Lantus ®) Long
Glulisine (Apidra ®) Rapid
Regular (Humulin R ®, Novolin R ®) Short
NPH (Humulin N ®, Novolin N ®) Long
Detemir (Levemir ®) Long
Lispro (Humalog ®) Short
Aspart (Novolog ®) Short

Question 7

Which insulins are available OTC?

Answer 7

Regular (Humulin R ®, Novolin R ®)

NPH (Humulin N ®, Novolin N ®)

Question 8

Which insulin is the most concentrated with 500 units/ml? Is this OTC or Rx?

Answer 8

Humulin R ®

This is Rx only!

Question 9

All of the following are matched correctly, except?

A. Glulisine: Apidra
B. Lantus: Humalog
C. Detemir: Levemir
D. Novolog: Aspart
E. NPH: Humulin N

Answer 9

(B) Lantus ® : Glargine

Humalog ® : Lispro

Question 10

All of the following are advantages of rapid acting insulins compared to regular insulin, except?

A. Can be injected with the first bite of the meal
B. Less likely to cause hypoglycemia b/c duration of action is more consistent with digestion time
C. Comes in a 10ml vial
D. A & B only
E. All of the above

Answer 10

(D) A & B only

Question 11

Which of the following insulins is a cloudy suspension?

A. NPH
B. Glargine
C. Levemir
D. A & B
E. A only

Answer 11

(E) A only - NPH is the only cloudy suspension. ALl other insulins are clear solutions

Question 12

This long-acting insulin forms a depot underneath the skin (micro-precipitates) b/c of pKa and pH and releases insulin consistently over 24 hours?

Answer 12

Glargine (Lantus ®)

Question 13

All of the following statements are true, except?

A. About 50% of insulin is cleared by the kidneys
B. Rapid insulin can be mixed with NPH in the same syringe
C. Regular insulin can be mixed with NPH in the same syringe
D. Glargine and Detemir can be mixed with NPH in the same syringe
E. C & D

Answer 13

(D) Glargine and Detemir CANNOT be mixed with NPH in the same syringe. They must be given SQ by themselves

Question 14

Which of the following statements is true?

A. One insulin injection is usually sufficient for a type 1 DM patient
B. Primary complication outcome of the DCCT trial was nephropathy
C. DCCT trial showed that intensive Tx (inject 4x/day) had a 2-3x higher risk of hypoglycemic episodes compared with conventional Tx (inject 2x/day)
D. HgA1c goal of

Answer 14

(E) C & D are both correct

A - Type 1 DM patients require multiple injection daily (at least 2) to mimic normal insulin release from pancreas.

B - The primary complication outcome of the DCCT trial was retinopathy

Question 15

Which of the following statements is false?

A. When a type 1 DM patient is feeling ill, they will require a larger dose of insulin than normal
B. Treat-to-Target algorithm insulin dosing for a type 2 diabetic patient starts with 10 units of a long acting insulin given HS
C. Insulin administered IV has a faster onset than insulin administered IM or SQ
D. SQ injection of insulin has a shorter DOA than insulin administered IV
E. Renal failure decreases insulin clearance

Answer 15

(D) SQ injection of insulin has a LONGER DOA than insulin administered IV

Onset of action rapid and DOA shorter for…
IV > IM > SQ

B - Glargine (Lantus ®), Detemir (Levemir ®), and NPH (Humulin N ®, Novolin N ®) are all options here

Question 16

When should insulin be added to a type 2 diabetic’s regimen?

Answer 16

When oral meds aren’t working that well.

Note that patient continues to take oral meds in addition to the insulin

Question 17

What is the initial dose of insulin for a type 1 DM patient? What is the dose for the “honeymoon phase?”

Answer 17

Type 1 initial insulin dose 0.5-0.6 Units/kg (use actual body weight)

Type 1 “honeymoon phase” dose 0.1-0.4 Units/kg (use actual body weight)

Question 18

How would you change the dose of insulin for a type 2 DM patient with a FPG diary that reads…

Today: 150
Yesterday: 142
2 days ago: 155
3 days ago: 159
4 days ago: 144

Answer 18

Based on the TTT (treat-to-target):

Take the average FPG of the preceding 2 days [(150 + 142)/2] = 146

Algorithm suggests to increase dose of insulin by 6 units per day

Mean FPG          Increase insulin dose (units/day)
> 180 mg/dL             8
140-180                    6
120-140                    4
100-120                    2

Question 19

Which of the following statements regarding a DM patient is false?

A. Patients who are sick with N/V should continue taking basic dose of insulin
B. Smoking decreases absorption of insulin
C. It is important to test urine for ketones when patient is sick
D. B & C
E. None of the above

Answer 19

(E) None of the above

A - When a patient gets sick, BS can rise very quickly so patient must continue taking basic dose of insulin and monitor BS frequently. If indicated, give supplemental dose of insulin (for every 50 mg/dL above normal BS - give 1-2 units of rapid)

Question 20

What are the (3) AE of injecting insulin?

Answer 20

1. hypoglycemia
2. weight gain
3. injection site reaction

Question 21

All of the following are appropriate courses of action if a patient finds themselves with BS

Answer 21

(E) A & C only

B - patient is unconscious so they can’t eat. Hypoglycemic patients that are still conscious should be advised to eat between 10 - 25g of carbohydrates

D - D5W does not have enough sugar to raptly rise from dangerous levels

Question 22

Which of the following medications is indicated for both type 1 and type 2 DM?

A. Metformin
B. Symlin ®
C. Starlix ®
D. Miglitol
E. Both B & D

Answer 22

(B) Symlin ® (Pramlintide), an amylin analogue, is indicated as an adjunct to Tx with mealtime insulin for both type 1 and type 2 DM patients

All others are indicated for type 2 DM
Metformin (Glucophage ®)
Nateglinide (Starlix ®)
Miglitol (Glyset ®)

Question 23

All of the following medications have NO EFFECT on insulin secretion, except?

A. Glipizide
B. Pioglitazone
C. Avandia ®
D. Repaglinide
E. Both A & D

Answer 23

(E) Both A & D
Glipizide (Glucotrol ®) and Repaglinide (Prandin ®) both increase B-cell secretion of insulin.

Glipizide (Glucotrol ®) is a Sulfonylurea
Repaglinide (Prandin ®) is a Meglitinide

Question 24

Which of the following medications would NOT require a dose adjustment in the treatment of a type 2 DM patient with renal insufficiency?

A. Invokana ®
B. Sitagliptin
C. Byetta ®
D. Victoza ®
E. Onglyza ®

Answer 24

(D) Liraglutide (Victoza ®) does NOT require any dosage adjustment in renal impairment

A - Canagliflozin (Invokana ®)
CrCl 45-60 ml/min: 100mg po once daily
CrCl

Question 25

All of the following DM medications increase B-cell secretion of insulin, except?

A. Amaryl ®
B. Glynase ®
C. Micronase ®
D. Diabeta ®
E. Avandamet ®

Answer 25

(E) Avandamet ® (Rosiglitazone/Metformin) has no effect on B-cell secretion of insulin. Rosiglitazone (Avandia ®) is from the class Thiazolidinediones (TZD) and binds to nuclear receptors and helps insulin move sugar back into tissue. Metformin (Glucophage ®) is from the class Biguanides and acts by decreasing glucose production in the liver and enhancing peripheral muscle glucose uptake

All other medications listed are sulfonylureas which do increase B-cell secretion of insulin

Question 26

Initial therapy for type 2 DM patients is largely selected based on HgA1%. What initial therapy is given for the following baseline HgA1C%’s:

< 9%
9 - 9.99%
>,= 10%

Answer 26

< 9% monotherapy
9 - 9.99% 2 drug combination
>,= 10% Insulin regimen with oral agent

3 oral agents are rarely used. If patient does not get controlled on 2 oral agents, most likely they will be started on an insulin regimen.

Question 27

True or False - there is no maximum insulin dose to get a DM patient to goal HgA1C%?

Answer 27

True

Question 28

Which of the following should ALL DM patients receive?

A. annual influenza vaccine
B. Pneumococcal and HepB vaccines
C. Moderate-intensity statin if patient is 40-75 y/o
D. 81mg ASA for DVT prophylaxis
E. All of the above

Answer 28

(E) All of the above

Question 29

Diabetic peripheral neuropathy is a complication of DM and is` characterized by tingling and numbness and can lead to infection. Give three examples of treatment for diabetic peripheral neuropathy?

Answer 29

TCA (amitriptilyne)
Pregabalin (Lyrica ®)
Gabapentin (Neuronton ®)

Question 30

Diabetic gastroparesis is a complication of DM. Give two examples of treatment for diabetic gastroparesis?

Answer 30

Erythromycin PO & IV (stimulates bowel movement)

Metoclopramide (stimulates GI movement)