Diabetes Jeopardy!

Diagnosis and Treatment

100

A1c diagnostic criteria for diabetes, fasting goal range, and 2-hour postprandial goal range for most patients

Greater than or equal to 6.5%

80-130 mg/dl

<180 mg/dl

200

Prediabetes A1c diagnostic criteria

5.7-6.4%

300

Goal A1c for pregnant patients with diabetes 

<6%

400

These individuals may have an A1c goal of less than 8%

Prone to hypoglycemia, limited life expectancy, important comorbidities, long duration of diabetes

500

Preprandial and 2-hour postprandial goals in pregnancy

<95 mg/dl, <120 mg/dl 

Case-Based

100

Emma is a 45 year old female with type 2 diabetes, asthma, and hypertension. Current medications include metformin 1000 mg BID, Symbicort 160/4.5 2 inhalations twice daily, and lisinopril 5 mg daily. Most recent A1c is 8.4%. She is hoping to lose some weight and get her A1c down, and is interested in a medication to help. What class of medications is most appropriate? 

GLP-1 RA 

200

A patient comes into your pharmacy and tells you that they are using Ozempic for diabetes. The patient has been using the medication for 4 weeks and has developed moderate, persistent abdominal pain. You explain that stomach upset is common, but abdominal pain is more concerning. You refer him to his primary care provider, and instruct him to go to the ER if this gets worse in the meantime. What are you concerned about? 

Pancreatitis

300

Ed has been using metformin 1000 mg BID, glyburide 5 mg BID, and Januvia 100 mg daily to manage diabetes for the last 5 years. His glucose has always been well controlled but recently he has noticed his glucose levels are climbing. Today's A1c comes back at 8.5%, previously 7.2% 3 months ago. He denies dietary or exercise changes. What do you suggest could be the culprit? 

Glyburide - sulfonylurea

B-cell burnout 

400

Beth is a 43 year old female with T2DM diagnosed 5 months ago, currently using metformin 1000 mg twice daily. Today, her A1c is 7.7%. PMH consists of HTN, HLD, and obesity. She'd like to lose weight. What do you recommend (provide a specific medication brand and generic name, and the dose). 

...

500

DAILY DOUBLE!

Mark is a 63 year old male with T2DM, obesity, hypertension, hyperlipidemia, and HFrEF. Current medications include metformin 1000 mg BID, pioglitazone 30 mg daily, lisinopril 10 mg daily, and  atorvastatin 80 mg daily. He is looking to add a medication which could help him to lose a little weight, but he doesn't want to do any injections. What two medication changes would be most appropriate in this case?

Discontinue pioglitazone

Initiate SGLT2i for weight loss and HFrEF

Brand and Generic (and class!)

100

Farxiga

Dapagliflozin

SGLT2i

200

Glucophage

Metformin (Biguanide)

300

Actos

Pioglitazone (Thiazolidinedione)

400

Glucotrol XL

glipizide XL 

Sulfonylurea

500

Tradjenta

Linagliptin
DPP4i

Calculations!

100

The weight based dosing range for initial basal insulin in type 2 diabetes

0.1-0.2 units/kg/day

200

Dr. Smith has a 140 lb male patient with T2DM and asks you to calculate the weight-based basal insulin dose range for starting the patient on Toujeo. 

6 - 13 units daily 

300

Kelly is a 25 year old female with type 1 diabetes. She weighs 120 lbs. Calculate her initial basal and bolus insulin dosing. Round to the nearest whole numbers. 

14 units basal, 5 units with each meal

400

Sam is a 40 year old male with T1DM. He is using Novolog 70/30, 50 units twice daily. His PCP wants to switch him to a glargine/lispro regimen. Calculate his new basal/bolus insulin dosing. 

100 units daily x .70 = 70 units of intermediate insulin

Reduce that by 20% = 70 x 0.8 = 56 units new basal insulin dose

The remaining 30 units of the current TDD is rapid acting split 3 ways. So 10 units with each meal.

500

Hannah is a 21 year old female with T1DM. She takes 40 units of degludec daily and 10 units of aspart before each meal. Her pre-dinner readings is 170 mg/dl (goal 110 mg/dl) and she plans to eat 85 g of carbs. What is her insulin:carb ratio? Insulin sensitivity? How much aspart does she need to inject before dinner?

500/TDD = 7 (1 unit of bolus insulin will cover 7 grams of carbs) 

1800/TDD = 26 (1 unit of bolus insulin will lower the BG 26 mg/dl) 

170-110/26 = Correction dose = 2

85/7 = 12 units of insulin + 2 unit correction = 14 units before dinner

Comprehensive Care

100

These immunizations are recommended for individuals with diabetes

Influenza, Pneumococcal, Hep B, Shingles, COVID-19, Tetanus

200

List the MACRO and MICROvascular complications associated with diabetes

Macro = MI, stroke

Micro = neuropathy, nephropathy, retinopathy

300

Goal BP, initial therapy drug classes, and monitoring parameters for management of hypertension

<130/80 mmHg

ACEi, ARB, DHP CCB, thiazide-like diuretics 

SCr, GFR, CMP (electrolytes), and BP 

400

Primary prevention recommendation in individuals 40-75 with one or more ASCVD risk factor

High intensity statin

500

Treatments for diabetic neuropathy, after optimizing glucose control

Pregabalin, duloxetine, or gabapentin