DM QUIZ endocrine

1- A 66-year-old Hispanic man with a history of myocardial infarction, dyslipidemia, and hypertension received a diagnosis of type 2 diabetes mellitus (DM). After 1 month of exercise and dietary changes and no diabetes medications, his hemoglobin A1c (A1c) and fasting glucose concentration today are 11.5% and 322 mg/dL, respectively. He weighs 273 lb with a body mass index (BMI) of 42 kg/m2. Which one of the following sets of drugs is best to initiate?

- A patient with type 2 DM is being converted from oral diabetes drug therapy to basal/bolus insulin with detemir and lispro insulins. His recent A1c is 9.1%, and his weight is 80 kg. Which of the following is the most appropriate initial dose of rapidacting
insulin before breakfast for this patient? Assume a total daily insulin (TDI) regimen of 0.5 unit/kg/day.

- A woman with type 2 DM has an A1c of 8.6%. She is receiving insulin glargine (60 units once daily at bedtime) and insulin aspart (8 units before breakfast, 7 units before lunch, and 12 units before dinner). She is very consistent in her carbohydrate intake at each meal. Her morning fasting plasma glucose (FPG) and premeal blood glucose (BG) readings have consistently averaged 112 mg/dL. Her bedtime readings are averaging between 185 and 200 mg/dL. Which one of the following is the best insulin adjustment to improve her overall glycemic control?

A 65-year-old man with type 2 DM for 6 years has been receiving metformin 1000 mg twice daily for the past 2 years. His A1c today is 7.8%. His fasting morning BG readings are consistently at goal. His after meal glucose readings average 190-200 mg/dL. Which one of the following options would be most appropriate for this patient?

- A 52-year-old woman has received a diagnosis today of type 2 DM. Her A1c today is 7.8% and her FBG today is 186 mg/dL. She has no other chronic disease states or history of cardiovascular disease. According to the current ADA guidelines, which one of the following would be considered the best initial treatment of choice for this patient?

- A 66-year-old man has had type 2 DM for 4 years and has a history of pancreatitis. His A1c today is 7.7%. He has altered his diet, and he states that he has been exercising regularly for months now. He currently is receiving metformin 1000 mg twice daily. Which one of the following would be the best choice to help optimize his glycemic control?

- A 66-year-old man is given a diagnosis of type 2 DM today. His A1c was 8.2%, and his serum creatinine was 1.8 mg/dL 2 weeks ago. He has a history of hypertension, dyslipidemia, and systolic heart failure (New York Heart Association class III, ejection fraction 33%). He has 2+ pitting edema bilaterally. In addition to improvements in diet and exercise, which one of the following is the best drug to initiate?

- A male patient with an A1c of 7.6% is receiving insulin detemir (60 units once daily at bedtime) and insulin lispro (6 units before breakfast, 5 units before lunch, and 8 units before dinner). His morning FPG concentrations have consistently been high for the past 3 weeks, averaging 160 mg/dL. He reports no daytime or nighttime hypoglycemia. Which one of the following is the best insulin adjustment to improve his overall glycemic control?

- A patient weighing 110 lb has been given a diagnosis of type 1 DM. The physician wishes to start at a TDI of 0.4 unit/kg/day with a combination of long- and rapid-acting insulin. The patient is unwilling to estimate his or her carbohydrate intake at this time. Which one of the following would be the most appropriate initial basal insulin regimen?

- A patient with type 1 DM has been initiated with basal/bolus insulin therapy. The patient receives 13 units once daily of insulin detemir. The patient is also receiving insulin lispro, 4 units before breakfast, 3 units before lunch, and 4 units before dinner. You are to initiate a correctional dosing strategy for the patient. Which of the following is the best estimate for the milligram per deciliter decrease in BG 1 unit of lispro that may be obtained?

- FD is a 44-year-old, healthy woman. Her father has diabetes mellitus. FD does not exercise and over the past 5 years has gained 20 pounds. During her last physical exam a fasting plasma glucose was noted to be 117 mg/dl. On repeat it was 115 mg/dl. Based on the new American Diabetes Association definition she has “pre-diabetes”. In addition to diet and exercise which of the following therapies are indicated at this time?

- AM is a 61-year-old, obese man with type 2 diabetes mellitus (diagnosed 4 years ago), atrial fibrillation, dyslipidemia, and microalbuminuria. His present regimen of glyburide 10 mg provides an A1c of 8.2%. SMBG reveals fasting blood glucose and predinner
levels averaging 159 mg/dl and 178 mg/dl, respectfully. DA’s diet is high in carbohydrates and he seldom exercises. Which one of the following therapies should be considered?

- A 48-year-old woman presents to the clinic today for a 6-month diabetes follow-up. She also has stage 3 chronic kidney disease (CKD). She has been taking metformin 500 mg by mouth twice daily for the past 5 years with no problems or concerns. Her current BMI (body mass index) is 29.2 kg/m2. She has had no changes in her meal planning or activity levels. Recently, she underwent some laboratory testing, and the values are as follows: hemoglobin A1C 7.7%; fasting plasma glucose 135 mg/dL; serum creatinine 1.5 mg/dL; and GFR (glomerular filtration rate) 37 mL/minute/1.73m2.
Which is the best option for improving this patient's diabetes control?

- When comparing and contrasting glucagon-like peptide-1 (GLP-1) and glucosedependent
insulin-releasing peptide (GIP) in regards to their incretin mechanism of action, it is clear that:

A patient with type 2 DM receiving premeal insulin is interested in a “new” drug that he heard would allow him to significantly decrease his premeal insulin doses and permit better glycemic control. Which is the best choice to allow this patient to decrease his premeal insulin doses and permit better glycemic control?