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Test Your Knowledge

Take a quiz and test your knowledge on diabetes and related health concerns.

Lifestyle Modifications

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Your 42-year-old, overweight patient was diagnosed with type 2 diabetes (A1C 7.7%) five months ago. You discussed the diagnosis with him, prescribed metformin, and provided lifestyle modification education resources. He missed his follow-up appointment, so you called him to schedule a return visit. At this appointment, he shares some of the positive lifestyle modifications he has made and that he has been taking his metformin consistently. He currently takes 2,000 mg metformin per day. At this visit, his A1C is 9.4%. All of the following are reasonable treatment options EXCEPT: A. Metformin+ lifestyle modifications B. Metformin + once-daily evening basal insulin dose + lifestyle modifications C. Metformin + sulfonylurea+ lifestyle modifications D. Metformin + GLP-1 receptor agonist + lifestyle modifications Follow the link to see the correct answer.

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Weight Loss Assistance

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A 41-year-old patient with a BMI of 39 kg/m2 returns for a follow-up visit 3 months after initiating metformin. She is highly sensitive to her weight and has tried to implement lifestyle modifications, but is finding it difficult to make any meaningful changes in her diet or exercise routines. Her current A1C is 7.7%, with a target goal A1C<7%. In addition to discussing consideration of bariatric surgery, which drug class might you add? A. Thiazolidinedione B. Sulfonylurea C. DDP-4 inhibitor D. GLP-1 receptor agonist Follow the link to see the correct answer.

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Medication Modification

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One of your patients is currently taking metformin, glyburide, and an evening basal dose of insulin. After discussing how best to achieve better glycemic control, he has agreed to add a pre-meal insulin dose. Which modification should be made with the addition of the prandial dose? A. Discontinue the glyburide B. Discontinue the metformin C. No modifications should be made D. Discontinue the metformin, glyburide, and evening insulin Follow the link for the correct answer.

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Which Insulin Do You Choose?

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One of your patients is a 3-state regional salesman who has a fairly unpredictable work schedule. When he gets hungry while on the road, he tends to eat at the first restaurant he sees. For the past 3 months, he has managed his type 2 diabetes with metformin, glipizide, and glargine. Despite this regimen, his current A1C is 7.8%. You are in agreement that he needs to add a bolus insulin dose to his regimen. Which type of insulin would be the most appropriate choice? 1. Rapid-acting insulin analogues 2. Premixed insulin 3. Long-acting insulin analogues 4. Intermediate-acting insulin Follow the link to see the correct answer.

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Antihyperglycemic Medications for Patients with Type 2 Diabetes

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The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) list a hierarchy of usage for antihyperglycemic medications after metformin. Which one of the following lists shows the correct hierarchy, beginning with the most preferred? A. A Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter 2 (SGLT-2) inhibitors, dipeptidyl peptidase 4 (DPP-4) inhibitors, thiazolidinediones (TZDs), basal insulins B. SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 RAs, TZDs, basal insulins C. TZDs, GLP-1 RAs, SGLT-2 inhibitors, DPP-4 inhibitors, basal insulins D. GLP-1 RAs, SGLT-2 inhibitors, basal insulins, DPP-4 inhibitors, TZDs Follow the link to see the right answer.

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Treatment Changes

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A 42-year-old patient was diagnosed with type 2 diabetes approximately one year ago and is currently taking metformin, a DPP-4 inhibitor, and a basal insulin dose (current daily dose .9 U/kg/day). Despite good compliance with her diet, exercise, and medication regimen, she reports postprandial glucose measurements of usually about 190 mg/dL. Her current A1C is 7.6%. Which of the following changes in her management do you consider most important? A. Add a sulfonylurea to her regimen B. Increase her basal insulin dose C. Add a pre-meal rapid-acting insulin D. Discontinue her basal insulin dose and add a prandial insulin dose Follow the link to see the answer.

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Impaired Renal Function

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At her last visit, your patient’s labs showed a eGFR 55 ml/min/1.73 m2. At this visit, her labs measured an eGFR of 44 ml/min/1.73 m2. Dose reduction/cessation should be considered for all of the following agents EXCEPT: A. Glyburide B. Sitaglipitin C. Metformin D. Pioglitazone Follow the link for the correct answer.

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Acanthosis nigricans

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Acanthosis nigricans presents as a brown to black pigmentation usually seen in the neck or armpit areas. In relation to diabetes, this may indicate: A) granuloma annulare B) diabetic dermopathy C) type 1 diabetes D) insulin resistance Follow the link to see the correct answer.

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Minimizing Side Effects

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Your patient has been newly diagnosed with type 2 diabetes (A1C 7.7%) and you have prescribed metformin. Metformin should be titrated to minimize which side effect? A. Rebound hyperglycemia B. Reactive hypoglycemia C. Weight gain D. Gastrointestinal-side effects Follow the link to see the answer.

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