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Test Your Knowledge

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

CGM Evaluation

What is most important when evaluating CGM?

A. Accurately evaluating glucose levels in the hypoglycemic range
B. Considering mean absolute relative differences in blood glucose (blood versus CGM value)
C. Considering patient-reported outcomes (positive experience and preference to or not to include CGM in their daily lives)
D. All of the above

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Real-Time CGM

Real-time continuous glucose monitoring (rtCGM) facilitates our understanding of the relationship between:

A. Food and blood glucose (BG)
B. Exercise and BG
C. Stress and BG
D. Variation in BG during menstrual cycle
E. All of the above

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High-Temp Cooking

According to a recent study, frequently consuming meat, poultry, or fish cooked at high temperatures increases the risk for hypertension by how much?

A. 11%
B. 17%
C. 23%
D. 25%
E. 38%

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Symptom Tracking

A 72-year-old patient arrives in your office complaining of shakiness and sweating before he went to bed the previous night. He doesn’t recall checking his blood glucose level at the time, however he felt better after a glass of milk and a few graham crackers. His current medications are metformin, pioglitazone, and glyburide. Which one of the following medications is the most likely cause of his symptoms?

A. Metformin
B. Pioglitazone
C. Glyburide

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Adding Prandial Insulin

Your patient has been systematically titrating his basal insulin dose for the last 6 months. His daily dose is NPH .90 U/kg/day. Despite his good efforts, you decide it would be prudent to add a prandial insulin dose to his treatment regimen. Which of the following scenarios might lead you to this conclusion?

A. A1C=7.4%, FPG less than 130 mg/dl, PPG greater than 180 mg/dl
B. A1C=7.0%, FPG less than 130 mg/dl, PPG less than 180 mg/dl
C. A1C=7.0%, FPG less than 120mg/dl, PPG less than 160mg/dl
D. A1C=6.8%, FPG less than 120 mg/dl, PPG less than 160 mg/dl

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CLINICAL CASE VIGNETTE: Antihyperglycemic Treatments

Mr. Huang is a 61-year-old Asian American businessman who comes in to see you for a follow-up appointment. He was diagnosed with type 2 diabetes four years ago and has a long-standing history (15 years) of hypertension and hypercholesterolemia, which are currently well-controlled. Current medications are metformin (1500 mg/day), lisinopril, and simvastatin. He has excess weight (BMI 29 kg/m2) but feels he has a healthy diet and gets out for a 25-30 minute walk 3 or 4 times per week. He feels great, but over the last nine months or so, he has noticed that his home average glucose levels are in the 180-198 mg/dL range. At today’s visit, his A1C is 8.3%. Based on Mr. Huang’s individual glycemic target of A1C<7%, you would like to add another antihyperglycemic. You choose linagliptin over glimepiride. What is the best reason for your choice?

A. Greater weight loss benefits
B. More effective at lowering blood glucose levels
C. Lower cost of treatment

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CLINICAL CASE VIGNETTES: Morning Distress

Mrs. Wilson is woman who is 71 years of age, African American and has excess weight. She has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, and aspirin, and has recently titrated to.6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is less than 7.5% and she has been working hard to get to that level. However, for the first time her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age,” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check her glucose was a few days ago. GHer postprandial glucose was “a little high” at 214 mg/dL. Her office A1C is 8.6%. Based on what you know about the patient, what is the most likely cause of her morning distress? A. Hyperglycemia B. Hypoglycemia C. Anxiety D. Cognitive decline Follow the link for the answer.

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