Standards of Care
A class of medication that has an A recommendation from the ADA for the treatment of hypertension in patients with diabetes.
What are ACEis or ARBs?
A 38 year old patient with DM was started on glargine 20u at last visit 2 weeks ago. Fasting BG over the last few days has been between 180 and 230. Your recommendations for uptitrating insulin.
What is?
- increase by ~2 units every couple days until fasting BG in goal range
- increase by ~2 units and have pt return / CDE follow-up phone call
3 side effects of an SGLT-2.
What is?
- vulvovaginal candidiasis
- bacterial UTIs
- hypotension
- electrolyte abnormalities
- euglycemic DKA
- amputation?
- Fournier's gangrene
The goal ranges of fasting and post-prandial blood glucose.
What is 80-130 mg/dl and <200 mg/dl?
A 47yo M with A1c 8% is normotensive with urine microalb/Cr 45 mg/g. He is on metformin. Your next step in DM management.
What is add an SLGT2i?
The ideal time interval after eating that one should check a post-prandial blood glucose.
What is 2 hours?
2 contraindications to GLP-1 agonists?
What is medullary thyroid cancer and pancreatitis?
(gastroparesis also acceptable)
Vaccines indicated for a 53 year old man with diabetes.
What is PCV20, hepatitis B, flu, COVID, Shingrix, tdap?
A 58 yo woman with DM returns for a visit. At her last visit 6 months ago POCT A1c was 8.2%. Her previous lab tests were 2 years ago. The labs you would order today.
What is BMP, A1c, lipids and urine microalb/Cr?
The insulin concentration of a standard insulin pen, and the total number of units contained in a standard insulin pen.
What is 100u/cc and 300u?
A 48 year old man with DM and obesity is on insulin glargine 20 units daily and insulin lispro 5 units before each meal. His A1c improved 11% to 7.4% then crept up to 8.7% He reports spotty adherence with mealtime insulin and occasional low readings before dinner. Your next step in management.
What is?:
- getting more blood glucose data or
- stopping prandial insulin and adding a GLP-1 agonist
The components of a SMART goal?
What is Specific, Measurable, Attainable, Relevant, Time-bound?
A 54yo patient with DM has an LDL of 120. Your recommendation regarding statin initiation.
What is start a high dose statin?
A 49 year old patient weighing 80kg is newly diagnosed with DM with an A1c of 15% and fasting glucose 280. Your starting dose of basal insulin.
What is?:
- ~16-24u (0.2-0.3u/kg) or
- 10-12u and uptitrate
The correct injection technique for semaglutide (Ozempic)? (or dulaglutide (Trulicity))
Demonstration.
You are covering overnight phone calls for IMA. The lab calls you with a – critical lab for patient with type 2 DM with glucose 150 and CO2 15. The most likely cause.
What is euglycemic DKA 2/2 a SGLT-2i?
3 ways to diagnose type 2 DM
What is?:
- A1c 6.5% or greater
- FBG 126mg/dl or greater
- Random BG 200mg/dl or greater
- OGG with BG 200mg/dl or greater
* ideally should be repeated
Your patient is on insulin glargine (Basaglar, 100u/cc) 66u and you recommend to transition to insulin degludec (Tresiba, 200u/cc). Morning BG ~100s-110s. The dose of Tresiba you tell the patient to administer.
What is ~60u?
A 69yo woman with an A1c of 8.6% is on glipizide 5 mg, metformin 1000 mg bid and sitagliptin (Januvia) 100 mg. Her GFR is now 38. Your medication adjustments.
What is decreasing metformin to 500mg BID, changing sitagliptin to GLP-1a (or decreasing sitagliptin to 50mg), and either stopping or being very cautious with glipizide?
A 37 year old man with obesity presents to you for hospital discharge follow-up after being managed in the ED for DKA. His A1c is 14.8%. He is currently taking insulin glargine 15units. He is not checking his blood sugar. Your short-term and long-term medical management plans for the patient.
What is treat in short-term with inuslin to control hyperglycemia and then introduce other medications. Long-term work on nutrition, exercise, getting off insulin. perhaps keep metformin and GLP1a.