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Test Your Knowledge

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

Medication Modification

Test Your Knowledge

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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GLP-1 Contraindications

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Which of the following are strict or relative contraindications to the use of some of the GLP-1 agonists? A. Multiple endocrine neoplasia (MEN) syndrome type 2 B. Personal or family history of medullar thyroid cancer C. Pancreatitis D. All of the above Follow the link to see the right answer.

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Medication Mystery

Test Your Knowledge

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? 1) Metformin 2) Pioglitazone 3) Glyburide Follow the link to see the right answer.

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