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Test Your Knowledge

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

Considering Medication Costs

A 47-year-old patient returns for a follow-up visit. He currently takes metformin 2000 mg daily, but is not achieving his glycemic target of A1C <7 %. His current A1C is 8.0%. You would like to add a second medication to his regimen, however, he voices concern that he is no longer covered by any health insurance and is worried about how to pay for his medications. Taking his concern into consideration, what drug would you add to metformin? A. DPP-4 inhibitor B. Thiazolidine C. Sulfonylurea D. Meglitinide E. SGLT2 Inhibitor F. GLP-1 Agonists Follow the link to see the answer.

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Initiating Therapy

One of your patients has referred her 21-year-old stepson for a new patient exam. He has recently arrived home from college for the summer and she is concerned because he always seems to be thirsty. When prompted, she recalls her husband saying his ex-wife struggled with her weight and took “pills for her blood sugar.” Physical examination is notable for mildly elevated BP (137/84) and BMI 26 kg/m2. He denies any cigarette or alcohol use, states his favorite activities revolve around video games, and that he doesn’t really enjoy any physical activities. Labs are notable for random plasma glucose 312 mg/dl, UA positive for glucose. What would your initial drug therapy strategy be? A. Initiate monotherapy with metformin B. Initiate a combination therapy with two noninsulin agents C. Initiate lifestyle modifications D. Initiate insulin therapy Follow the link for the answer.

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Insulin Pens Vs. Vial and Syringe?

You have decided that one of your patients, a 72-year-old, should add a basal insulin dose to her antihyperglycemic regimen. During your discussion with her, she voices concern that between her “arthritic hands and poor vision” she won’t be able to accomplish this. You make the recommendation that using an insulin pen will make injection easier for her. Which of the following statements regarding insulin pens is true? A. They all require loading with an insulin cartridge. B. They have more accurate dosing than syringes. C. They can now dose insulin in .10 units increments. D. They are now available for all types of insulin. Follow the link for the answer.

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Implementing Insulin Change

A 47-year-old patient has done an excellent job with lifestyle modifications and medication adherence. However, she has not been able to yet achieve her individualized A1C goal. Her current regimen consists of a metformin, sitagliptin, and insulin detemir (insulin started 4 months prior). However, over the past month as she has titrated her basal insulin toward her A1C goal, her self-glucose blood monitoring log shows large drops in her overnight glucose levels. After consulting with the treatment team, you decide to add rapid-acting prandial insulin to her regimen. How would you implement this strategy? A. Decrease the basal insulin dose and add 1 daily prandial injection before the smallest meal of the day. B. Decrease the basal insulin dose and add 1 daily prandial injection before the largest meal of the day. C. Maintain the basal insulin dose and add 1 daily prandial injection before the smallest meal of the day. D. Maintain the basal insulin dose and add 1 daily prandial injection before the largest meal of the day. Follow the link for the answer.

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A1C Treatment Plan

A 54-year-old male presents to your office for an initial visit. His past medical history is significant for hypertension, hypertriglyceridemia and acute pancreatitis. His current lab results show an A1C 9.1%, which is confirmed on a repeat lab. You would like to start him on an antihyperglycemic treatment regimen. Which of the following two-drug combinations is contraindicated for this patient? A. Metformin + a sulfonylurea B. Metformin + an insulin C. Metformin + a meglitinide D. Metformin + a GLP-1 receptor agonist Follow the link to get the answer.

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Treating Increased A1C

Test Your Knowledge

A 64-year-old female presents to your office for her 3-month follow-up. She has previously been diagnosed with mild diastolic heart failure, secondary to hypertension. She currently takes an ace-inhibitor and a diuretic with good control of her heart failure symptoms and hypertension. At her last visit, she had a FPG 118 mg/dl. In a subsequent conversation with her, you discussed how she has developed prediabetes and suggested lifestyle modifications. Since her last visit, she has taken up very gentle walking four times/week and has changed her diet to a more healthful one. Despite these positive changes, this visit’s labs return an A1C 7.8%; her remaining labs are within normal limits. Which one of the following antihyperglycemic medication classes would you choose to initiate treatment? A. Sulfonylureas B. Biguanides C. Insulin D. Thiazolidinediones Follow the link for the answer.

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Achieving A1C Target

Test Your Knowledge

Your patient has been taking metformin, glipizide, and a daily basal insulin dose (.85 U/kg/day). While his fasting glucose levels are on target, he has not yet been able to reach his individualized glycemic target of A1C<7%. In your discussion with him about the addition of a prandial insulin dose to his regimen, you compare and contrast his options. Compared to basal insulin alone, premixed insulins: A. tend to lower A1c to a larger degree. B. are associated with less weight gain. C. cause less hypoglycemia. D. are a good option for people with irregular meal schedules. Follow the link to see the right answer.

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Pioglitazone Changes

Test Your Knowledge

A 62-year-old Asian-American female arrives at your office for a new patient appointment. Her current medications are metformin, pioglitazone, enalapril, lovastatin, alendronate, calcium supplements and vitamin D. Her A1C is on target at 6.9%, however you decide to replace her pioglitazone with a different antihyperglycemic medication. Why would you make this decision? A. Pioglitazone increases the risk of hypertriglyceridemia B. Pioglitazone increases the risk for cardiovascular events C. Pioglitazone increases the risk for fractures D. Pioglitazone increases the risk for hypoglycemia Follow the link to see the right answer.

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Minimizing Weight Gain

Test Your Knowledge

A 43-year-old patient with a 2-year history of type 2 diabetes presents to your office for a follow-up visit. She is a highly motivated patient and doesn’t have any significant co-morbidities, so together, you have set a target A1C= 6.5%. Her current medications are metformin and sulfonylurea. Despite her good efforts, her current A1C is 7.3%. You would like to add a third agent to her regimen, however, she is concerned about any additional weight gain as she has gained a few pounds since starting the sulfonylurea. Which drug class would you add to minimize any additional weight gain? A. Basal insulin B. GLP-1 agonist C. Thiazolidine D. DPP-4 Inhibitor

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Lifestyle Modifications

Test Your Knowledge

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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