Basal Insulin Titration Quiz
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Questions and Answers

Which of the following is true about the starting dose of basal insulin?

  • The starting dose is typically 8-10 units (correct)
  • The starting dose is usually the end dose
  • The starting dose is given in the morning
  • The starting dose is adjusted based on the pre-dinner reading

    • What is the main message regarding the administration of subcutaneous insulin injections?

  • It is difficult for patients to manage
  • It requires detailed dietary advice
  • It can completely eliminate the risk of hypoglycemia
  • It is easily managed by the patient (correct)

    • What is the 'start low go slow' approach?

  • Starting with a low insulin dose and increasing it slowly (correct)
  • Starting with a high insulin dose and decreasing it quickly
  • Starting with a high insulin dose and increasing it quickly
  • Starting with a low insulin dose and decreasing it slowly

    • What is the suggested timeframe for a review during the early phases of insulin treatment?

    <p>Within 7 days</p> Signup and view all the answers

    What is the suggested adjustment of insulin dose in insulin-resistant patients?

    <p>10% of the total daily dose of insulin</p> Signup and view all the answers

    What is the advantage of continuing metformin and other agents at the commencement of insulin?

    <p>It improves glucose levels from baseline</p> Signup and view all the answers

    What is the suggested increase in total daily dosage of insulin when oral therapy is discontinued?

    <p>20-30 units</p> Signup and view all the answers

    Which of the following is a core pathophysiological defect leading to the development of T2DM?

    <p>All of the above</p> Signup and view all the answers

    What is the term used to describe the impairment of beta cells due to 'glucolipotoxicity'?

    <p>Beta cell dysfunction</p> Signup and view all the answers

    Which tissues play a key role in glucose homeostasis and are targets for newer therapies for T2DM?

    <p>Adipose tissue and gastrointestinal tract</p> Signup and view all the answers

    When should early insulin therapy be considered in a patient newly diagnosed with T2DM?

    <p>All of the above</p> Signup and view all the answers

    What should prompt consideration of T1DM as the diagnosis in a patient with T2DM?

    <p>Marked ketonuria or ketoacidosis</p> Signup and view all the answers

    When is initiating insulin therapy in a patient newly diagnosed with T2DM unusual?

    <p>None of the above</p> Signup and view all the answers

    What should be considered when a patient with T2DM presents with marked ketonuria or ketoacidosis?

    <p>Both A and B</p> Signup and view all the answers

    Which therapy is recommended as a second-line agent to metformin in the treatment of T2DM, depending on clinical context?

    <p>Insulin</p> Signup and view all the answers

    What is the recommended treatment for elderly patients without microvascular disease, whose prognosis is driven mainly by macrovascular risk and for whom stringent glycaemic control offers fewer benefits?

    <p>Higher glycaemic threshold before insulin initiation</p> Signup and view all the answers

    When should insulin treatment be considered in patients with an HbA1c above 9% on maximally tolerated oral therapy?

    <p>After 3 months of persistent elevation in HbA1c</p> Signup and view all the answers

    What is the 'legacy effect' of early good glycaemic control in diabetes?

    <p>Reduction in complications and mortality</p> Signup and view all the answers

    What is the primary aim when initiating insulin therapy in patients with T2DM?

    <p>To avoid hypoglycaemia</p> Signup and view all the answers

    What is the average HbA1c reduction achieved by attention to lifestyle alone in patients with T2DM?

    <p>10 mmol/L</p> Signup and view all the answers

    Which insulin formulations may be useful in patients who need to cover both fasting and post-prandial glucose?

    <p>Premixed insulin analogues</p> Signup and view all the answers

    Which of the following is a possible option for controlling post-prandial rises in patients with elevated HbA1c?

    <p>Administering a short-acting insulin analogue before the larger meal</p> Signup and view all the answers

    In patients with T2DM, is it usually necessary to provide detailed insulin-to-carbohydrate ratios?

    <p>No, it is not usually necessary</p> Signup and view all the answers

    What is the purpose of administering a dummy injection of saline in early consultations for patients initiating insulin therapy?

    <p>To demystify insulin delivery</p> Signup and view all the answers

    Which needle size is suitable for most patients initiating insulin therapy?

    <p>6 mm</p> Signup and view all the answers

    Who can provide great assistance in the management of insulin therapy in patients with T2DM?

    <p>Diabetes nurse educators and registered dietitians</p> Signup and view all the answers

    What should be reviewed in relation to driving licenses and occupational hazards in patients initiating insulin therapy?

    <p>The patient's obligations</p> Signup and view all the answers

    Can insulin therapy be initiated simply and safely in the ambulatory care setting?

    <p>Yes, it can be initiated simply and safely</p> Signup and view all the answers

    What can assist the successful transition to insulin therapy in patients with T2DM?

    <p>All of the above</p> Signup and view all the answers

    What is the typical age of onset for latent autoimmune diabetes in adults (LADA)?

    <p>35 years</p> Signup and view all the answers

    What is one characteristic that can help distinguish LADA from type 1 or type 2 diabetes?

    <p>Negative test for autoantibodies</p> Signup and view all the answers

    What is the key reason for establishing distinct practice guidelines for the diagnosis and treatment of LADA?

    <p>To improve patient safety and treatment efficacy</p> Signup and view all the answers

    What is the main challenge in diagnosing LADA?

    <p>Similarities with type 1 and type 2 diabetes</p> Signup and view all the answers

    What is the primary aim when initiating insulin therapy in patients with type 2 diabetes?

    <p>To achieve normal blood glucose levels</p> Signup and view all the answers

    What is one characteristic of LADA that distinguishes it from type 1 diabetes?

    <p>Onset at a younger age</p> Signup and view all the answers

    What is one characteristic of type 2 diabetes that can help distinguish it from LADA?

    <p>Positive response to lifestyle modifications and oral agents</p> Signup and view all the answers

    What is one characteristic of LADA that can help distinguish it from type 2 diabetes?

    <p>Negative response to lifestyle modifications and oral agents</p> Signup and view all the answers

    Which marker is often measured to differentiate the types of diabetes?

    <p>C-peptide</p> Signup and view all the answers

    Which antibodies are commonly found in latent autoimmune diabetes in adults (LADA)?

    <p>All of the above</p> Signup and view all the answers

    What is the proposed age criterion for diagnosing LADA?

    <p>≥30 years</p> Signup and view all the answers

    Which antibody is often negative in type 2 diabetes but can be positive in LADA?

    <p>Islet cell autoantibodies (ICA)</p> Signup and view all the answers

    What is the recommended treatment for LADA?

    <p>Insulin therapy</p> Signup and view all the answers

    What is the main disadvantage of misdiagnosing LADA as type 2 diabetes?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic decline of C-peptide levels in LADA compared to type 2 diabetes?

    <p>Faster decline</p> Signup and view all the answers

    What is the proposed time frame for not treating LADA with insulin after diagnosis to meet the criteria?

    <p>Within 6 months</p> Signup and view all the answers

    Which antibodies are often positive in LADA?

    <p>All of the above</p> Signup and view all the answers

    Which type of diabetes is estimated to have a prevalence of 1-2% of all diabetes cases?

    <p>GCK-MODY</p> Signup and view all the answers

    What genetic test was performed to confirm the diagnosis of GCK-MODY?

    <p>Genetic MODY panel through a massive sequencing</p> Signup and view all the answers

    Which of the following is true about MODY diabetes?

    <p>It is more commonly found in Europe and North America</p> Signup and view all the answers

    What is the genetic cause of GCK-MODY?

    <p>A pathogenic variant in the GCK gene</p> Signup and view all the answers

    What is the recommended treatment for GCK-MODY?

    <p>Oral medication (metformin)</p> Signup and view all the answers

    What is the characteristic feature of GCK-MODY?

    <p>Low insulin requirements</p> Signup and view all the answers

    What is the significance of the negative result for the GCK variant in the parents of the patient?

    <p>It suggests that the parents are not the source of the variant</p> Signup and view all the answers

    What is the purpose of the Oral Glucose Tolerance Test (OGTT) in the diagnosis of MODY?

    <p>To evaluate pancreatic response</p> Signup and view all the answers

    Which gene is associated with MODY and was confirmed in the patient described in the text?

    <p>GCK</p> Signup and view all the answers

    What is the characteristic of hyperglycemia in GCK-MODY?

    <p>It is only detected when blood glucose is measured incidentally</p> Signup and view all the answers

    What is the prevalence of de novo mutations in GCK-MODY cases according to recent publications?

    <p>Low prevalence</p> Signup and view all the answers

    What is the first step in classifying a patient suspected of having MODY diabetes?

    <p>Medical evaluation</p> Signup and view all the answers

    What is the main advantage of genetic evaluation in patients with clinical suspicion of MODY diabetes?

    <p>To confirm the diagnosis</p> Signup and view all the answers

    What is the key message regarding the frequency of other specific types of diabetes in Latin America?

    <p>The frequency is unknown</p> Signup and view all the answers

    Which gene mutation is frequently misdiagnosed and unnecessarily treated as GCK-MODY?

    <p>HNF1A</p> Signup and view all the answers

    What is the term used to describe the condition of having both hypoglycemia and hyperglycemia syndromes caused by mutations in the glucokinase gene?

    <p>GCK-MODY</p> Signup and view all the answers

    Which gene mutations may be more frequent in MODY than previously assumed?

    <p>GCK</p> Signup and view all the answers

    Which gene mutation is associated with maturity-onset diabetes of the young, permanent neonatal diabetes, and hyperinsulinemic hypoglycemia?

    <p>GCK</p> Signup and view all the answers

    Which gene mutation is commonly found in latent autoimmune diabetes in adults (LADA)?

    <p>HNF1A</p> Signup and view all the answers

    Which gene mutation should be considered when a patient with type 2 diabetes presents with marked ketonuria or ketoacidosis?

    <p>HNF1A</p> Signup and view all the answers

    Which gene is associated with GCK-MODY, one of the most frequent subtypes of MODY?

    <p>GCK gene</p> Signup and view all the answers

    What is the estimated percentage of all diabetes cases that are accounted for by MODY?

    <p>1-2%</p> Signup and view all the answers

    Which of the following is NOT a characteristic of MODY that can help in its diagnosis?

    <p>Presence of Diabetic ketoacidosis (DKA)</p> Signup and view all the answers

    Which of the following statements about GCK-MODY is TRUE?

    <p>It is characterized by absence of glucokinase activity</p> Signup and view all the answers

    How many different GCK-MODY mutations have been reported to date?

    <p>Over 600</p> Signup and view all the answers

    What is the genetic inheritance pattern of GCK-MODY?

    <p>Autosomal dominant</p> Signup and view all the answers

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