Diabetes Management Quiz: Selecting the Best Agent

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Questions and Answers

What triggers the release of insulin?

Decreased blood glucose levels

Increased blood glucose levels (correct)

Low calcium levels

High blood pressure

In type 1 diabetes management, what is the role of insulin?

Suppressing hepatic glucose production

Causing weight loss

Increasing blood glucose levels

Replacing endogenous insulin (correct)

What does basal insulin do?

Increases hepatic glucose production

Promotes weight loss

Causes hypoglycemia

Regulates blood glucose between meals (correct)

When is bolus insulin released and delivered exogenously?

After meals to manage the rise in blood glucose Signup and view all the answers

What is the most common adverse effect associated with insulin therapy?

Hypoglycemia Signup and view all the answers

What is the primary function of rapid-acting insulin in diabetes management?

To provide a bolus of insulin at mealtime Signup and view all the answers

What medication would be recommended to improve PJ's diabetes control based on his current regimen?

Liraglutide injected once daily Signup and view all the answers

Which of the following medications is not recommended in renal impairment due to unknown effects?

Exenatide injected subcutaneously twice weekly Signup and view all the answers

What medication does Mr. Jones pick up at the community pharmacy counter according to the prescription details provided?

Trulicity (Dulaglutide) 0.75 mg, Inject into the skin once weekly Signup and view all the answers

Which medication is administered by injection once every week?

Trulicity (Dulaglutide) 0.75 mg, Inject into the skin once weekly Signup and view all the answers

What side effects is Mr. Jones likely to experience with the prescribed medication?

Nausea and diarrhea Signup and view all the answers

What medication did Ned start taking a year later to help with his glucose levels?

Lantus insulin Signup and view all the answers

What medication did Ned stop taking about 6 months ago due to cost?

Dulaglutide Signup and view all the answers

What is Ned's current weight a year later?

112 kg Signup and view all the answers

What is Ned's current A1c level a year later?

7.8% Signup and view all the answers

What type of insulin did Ned start with before managing his glucose elevations prior to meals a month later?

Insulin lispro Signup and view all the answers

Where is the recommended site for administering insulin?

Subcutaneously Signup and view all the answers

How many pens are needed to fulfill a 30-day supply of Continuous Glucose Monitors (CGMs)?

2 pens Signup and view all the answers

What is the purpose of High and low alerts on CGMs?

To alert the patient to rapid changes in glucose levels Signup and view all the answers

Why may a Continuous Glucose Monitor require calibration with fingerstick readings?

To ensure accurate readings Signup and view all the answers

Which Insulin Pump integrates with the Dexcom G6 or G7 CGM?

Tandem T:slim X2 with Control IQ Technology Signup and view all the answers

What is the estimated starting total daily dose of insulin for Jessie, a 65-pound 10-year-old female newly diagnosed with Type 1 Diabetes?

32.5 units/day Signup and view all the answers

Which sensor provides 'Real-time' glucose monitoring among the available CGM products mentioned?

Dexcom G6 Signup and view all the answers

What is the purpose of adjusting or discontinuing sulfonylureas with initiation of insulin therapy?

To lower the risk of hypoglycemia Signup and view all the answers

When should NPH insulin be converted to twice daily dosing?

If the A1c remains above target Signup and view all the answers

Which of the following medications is an insulin sensitizer and may be continued with insulin therapy despite common weight gain?

Thiazolidinediones (TZDs) Signup and view all the answers

Why is it recommended to balance the injection burden when combining GLP-1 receptor agonists with prandial insulin?

To avoid excessive injections Signup and view all the answers

What adjustment should be made if fasting blood sugars remain consistently high despite the initiation of NPH insulin therapy?

Increase the evening dose of NPH insulin Signup and view all the answers

Why are DPP-4 inhibitors usually weaned or discontinued when initiating insulin therapy?

Because of limited effectiveness in reducing glycated hemoglobin Signup and view all the answers

Study Notes

Non-Invasive Glucose Monitoring

Continuous Glucose Monitors (CGMs) measure interstitial glucose through a sensor placed below the skin, replaced every 7-10 days, and read on a receiving device.
CGMs require calibration with fingerstick and have high and low alerts for rapid rises and falls in blood glucose and when values cross programmed thresholds.
They integrate with insulin pumps to provide closed-loop artificial pancreas technology.
Best results are achieved with consistent (daily) use.

Insulin Initiation and Titration

Insulin initiation for T1DM involves both long-acting and rapid-acting insulin, based on weight, with a total daily dose of 0.5 units/kg/day.
The amount is split 50% between long-acting insulin and 50% rapid-acting insulin analog.
Insulin dosing for T2DM involves long-acting insulin to suppress hepatic glucose production, leading to improved glucose utilization overnight and in between meals, and rapid-acting insulin to improve glucose utilization at mealtime.

Insulin Overview

Insulin is released in response to increased blood glucose levels.
Glucagon is released in response to decreased blood glucose levels.
Insulin's physiologic actions include facilitating glucose uptake in cells, inhibiting glucose production in the liver, and promoting glycogen synthesis.
Insulin replacement in T1DM and long-acting insulin in T2DM suppresses hepatic glucose production, leading to improved glucose utilization overnight and in between meals.
Adverse effects of insulin include injection site reactions, hypoglycemia, and weight gain.

Basal and Bolus Insulin

Basal insulin, also referred to as background insulin, regulates blood glucose between meals and is released 24 hours a day.
Bolus insulin is released in response to food ingestion and manages the rise in blood glucose that occurs with absorption of carbohydrates and other mixed foods.
When delivered exogenously, basal insulin is injected once or twice a day, and bolus insulin is delivered prior to meals and/or snacks or in between meals to correct elevated blood glucose.

Adjusting Oral Diabetes Medications with Insulin Initiation

Metformin should be continued.
SGLT-2 inhibitors are usually continued with insulin therapy.
Thiazolidinediones (TZDs) may be continued, although weight gain is common.
Sulfonylureas and DPP-4 inhibitors are typically weaned or discontinued.
Glinides should typically not be used, especially as you progress to prandial/bolus insulin.
GLP-1 receptor agonists are often used with basal insulin, with prandial insulin, must balance injection burden.

NPH Insulin Initiation and Titration

NPH insulin is intermediate-acting insulin, initially dosed once a day at bedtime, 10 units or 0.1 to 0.2 units/kg/day.
If A1c remains above target, NPH insulin can be converted to twice daily, 2/3 of total daily dose (TDD) before breakfast, and 1/3 of TDD in the evening (usually at bedtime).
Titration: 2 units every 2 to 3 days based on FASTING blood sugars.

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Description

Test your knowledge on diabetes management by selecting the best agent to add to a patient's regimen for improved diabetes control. The scenario involves a patient with type 2 diabetes, previous myocardial infarction, and hypertension.