When blood glucose levels are difficult to control in type II diabetes, some form of insulin may be added to the treatment regimen to control blood glucose and limit complications risks. Which of the following statements are accurate based on research?
Premixed insulin analogues are better at lowering hemoglobin A1c and have less risk for hypoglycemia.
Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
Newer premixed insulins are better at lowering hemoglobin A1c and postprandial glucose levels than are long-acting insulins.
Patients who are not controlled on oral agents and have postprandial hyperglycemia can have NPH insulin added at bedtime.
Question 2. Lispro is an insulin analogue produced by recombinant deoxyribonucleic acid (DNA) technology. Which of the following statements about this form of insulin is not true?
The optimal time of preprandial injection is fifteen minutes.
The duration of action is increased when the dose is increased.
It is compatible with NPH insulin.
It has no pronounced peak.
Question 3. Unlike most type II diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is:
Weight loss in previously overweight persons
Involuntary loss of 10% of body weight in less than six months
Decline in lean body mass over a twelve-month period
Increase in central versus peripheral body adiposity
Question 4. Sulfonylureas may be added to a treatment regimen for type II diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:
Increase endogenous insulin secretion.
Have a significant risk for hypoglycemia.
Address the insulin resistance found in type II diabetics.
Improve insulin binding to receptors.
Question 5. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:
Metformin and insulin
Sulfonylureas and insulin glargine
Split-mixed dose insulin and GLP-1 agonists
Biguanides and insulin lispro
Question 6. Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:
Increase blood glucose levels.
Produce unexplained diaphoresis.
Interfere with the ability of the body to metabolize glucose.
Mask the signs and symptoms of altered glucose levels.
Question 7. Diagnostic criteria for diabetes include:
Fasting blood glucose greater than 140 mg/dl on two occasions
Postprandial blood glucose greater than 140 mg/dl
Fasting blood glucose 100 to 125 mg/dl on two occasions
Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
Question 8. Adam has type I diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that:
He should increase his CHO intake during times of exercise.
Each brand of insulin is equal in bioavailability, so buy the least expensive.
Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts.
If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes.
Question 9. Both ACE inhibitors and some angiotensin-II receptor blockers have been approved in treating:
Hypertension in diabetic patients
Both A and B
Neither A nor B
Question 10. Before prescribing metformin, the provider should:
Draw a serum creatinine level to assess renal function.
Try the patient on insulin.
Prescribe a thyroid preparation if the patient needs to lose weight.
All of the above options are .
Question 11. DPP-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:
Better reduction in glucose levels than other classes
Less weight gain than sulfonylureas
Low risk for hypoglycemia
Can be given twice daily
Question 12. Prior to prescribing metformin, the provider should:
Draw a serum creatinine to assess renal function.
Try the patient on insulin.
Tell the patient to increase iodine intake.
Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions.
Question 13. Type II diabetes is a complex disorder involving:
Absence of insulin production by the beta cells
A suboptimal response of insulin-sensitive tissues especially in the liver
Increased levels of glucagon-like peptide in the post-prandial period
Too much fat uptake in the intestine
Question 14. Type I diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type I diabetics have:
Autoantibodies to two tyrosine phosphatases
Mutation of the hepatic transcription factor on chromosome 12
A defective glucokinase molecule due to a defective gene on chromosome 7p
Mutation of the insulin promoter factor
Question 15. GLP-1 agonists:
Directly bind to a receptor in the pancreatic beta cell.
Have been approved for monotherapy.
Speed gastric emptying to decrease appetite.
Can be given orally once daily.
Control targets for patients with diabetes include:
Hemoglobin A1c between 7 and 8
Fasting blood glucose levels between 100 and 120 mg/dl
Blood pressure less than 130/80 mm Hg
LDL lipids less than 130 mg/dl
Question 17. When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?
Give two-thirds of the total dose in the morning and one-third in the evening.
Give 0.3 units/kg of premixed 70/30 insulin, with one-third in the morning and two-thirds in the evening.
Give 50% of an insulin glargine dose in the morning and 50% in the evening.
Give long-acting insulin in the morning and short-acting insulin at bedtime.
Question 18. All diabetic patients with hyperlipidemia should be treated with:
3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors
Fibric acid derivatives
Question 19. Metformin is a primary choice of drug to treat hyperglycemia in type II diabetes because it:
Substitutes for insulin usually secreted by the pancreas
Decreases glycogenolysis by the liver
Increases the release of insulin from beta cells
Decreases peripheral glucose utilization
Question 20. Sitagliptin has been approved for:
Monotherapy in once-daily doses
Combination therapy with metformin
Both A and B
Neither A nor B
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