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1 | |
Your patient’s daughter, Lulu, is also a patient of yours. She has recently become pregnant for the first time and comes to you concerned about the possibility of “pregnancy diabetes,” in view of her father’s condition.
What is the best INITIAL test for the presence of gestational diabetes? |
| | A) | Fasting blood glucose. |
| | B) | Random blood glucose. |
| | C) | 100-gram oral glucose tolerance test (OGTT). |
| | D) | 50-gram glucose challenge test (GCT). |
| | E) | Hemoglobin A1c. |
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2 | |
Lulu is found to have gestational diabetes and is managed successfully through her pregnancy by you and an obstetrical colleague. At her 6-week postpartum visit you obtain a fasting glucose of 113 mg/dL; repeated 3 days later it is 119 mg/dL.
What is the most appropriate next step? |
| | A) | Repeat FBG in about three years. |
| | B) | Begin drug therapy with metformin immediately. |
| | C) | Develop an intensive program of diet and exercise in collaboration with a dietitian and diabetes educator. |
| | D) | Begin insulin therapy. |
| | E) | No further intervention is indicated. |
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3 | |
The patient’s father (remember him?) has developed persistent hyperglycemia despite being on maximal doses of metformin, glipizide, and pioglitazone. He is willing to begin insulin therapy, but wants to give himself as few injections as possible.
Which of the following regimens would be best for him? |
| | A) | A single injection of insulin glargine (Lantus) at bedtime. |
| | B) | A single injection of 70/30 NPH/regular insulin at bedtime. |
| | C) | A baseline bedtime injection of insulin glargine at bedtime, and up to 3 injections of short-acting insulin with meals. |
| | D) | Two-thirds of the total daily insulin dose (divided two-thirds NPH and one-third regular) in the morning, and the remainder (divided fifty-fifty, NPH and regular) in the evening. |
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4 | |
Your patient is hospitalized for acute diverticulitis and requires urgent partial colectomy.
Which of the following statements regarding the management of diabetes in hospitalized patients is TRUE? |
| | A) | Hyperglycemia in the hospital has minimal if any effect on outcomes of myocardial infarction. |
| | B) | A standardized sliding-scale insulin regimen is adequate to control hyperglycemia in all hospitalized diabetic patients. |
| | C) | Insulin requirements will be lower for acutely ill hospitalized diabetic patients. |
| | D) | Metformin should be discontinued in seriously ill hospitalized patients. |
| | E) | A calorie-restricted clear liquid ADA diet is an appropriate choice for refeeding diabetic patients after gastrointestinal surgery. |
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5 | |
Because of your excellent diabetes management skills, the patient has attained good glycemic control by means of a regimen of 28 units, metformin and pioglitazone.
How often should he measure his blood glucose? |
| | A) | Once or twice a week, at varying times during the day. |
| | B) | Four times daily, before meals and at bedtime. |
| | C) | Twice a day, fasting and 2 hours after a meal. |
| | D) | Once or twice a day, fasting and before a meal. |
| | E) | Routine blood sugars are not indicated on a daily basis for type 2 diabetics. |
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