BC ADM Complications Management 4 — Questions and Answers
Question 1: A diabetic patient with gastroparesis has erratic postprandial glucose levels. Which insulin timing strategy is most appropriate?
- Administer rapid-acting insulin after meals once food intake is confirmed (Correct answer)
- Give insulin 30 minutes before meals as standard
- Double basal insulin dose
- Switch to premixed insulin twice daily
Correct answer: Administer rapid-acting insulin after meals once food intake is confirmed
Post-meal rapid-acting insulin administration avoids hypoglycemia from unpredictable gastric emptying causing delayed glucose absorption.
Question 2: Which test is considered the gold standard for diagnosing diabetic gastroparesis?
- Gastric emptying scintigraphy at 4 hours (Correct answer)
- Upper endoscopy
- Barium swallow study
- Wireless motility capsule alone
Correct answer: Gastric emptying scintigraphy at 4 hours
4-hour solid-phase gastric emptying scintigraphy is the gold standard, with retention >10% at 4 hours confirming gastroparesis.
Question 3: A patient with long-standing T1DM reports orthostatic dizziness. Blood pressure drops 28 mmHg systolic upon standing. What is the recommended initial management?
- Increase fluid and salt intake, compression stockings, and head-of-bed elevation (Correct answer)
- Immediate IV fluid bolus
- Start antihypertensive dose reduction only
- Beta-blocker therapy
Correct answer: Increase fluid and salt intake, compression stockings, and head-of-bed elevation
Non-pharmacological measures (fluid/salt loading, compression, head-of-bed elevation) are first-line for diabetic autonomic orthostatic hypotension.
Question 4: Which finding on nerve conduction study confirms diabetic peripheral neuropathy?
- Reduced sural nerve sensory conduction velocity and amplitude (Correct answer)
- Increased motor unit action potential duration
- Normal F-wave latency with abnormal H-reflex
- Increased conduction velocity with decreased amplitude
Correct answer: Reduced sural nerve sensory conduction velocity and amplitude
Reduced sural nerve sensory conduction velocity and amplitude are the earliest and most sensitive NCS findings in diabetic neuropathy.
Question 5: A patient with diabetic nephropathy is on an ACE inhibitor but still has urine ACR of 380 mg/g. Adding which drug class provides additional renoprotection per 2024 ADA guidelines?
- Finerenone (non-steroidal MRA) (Correct answer)
- Spironolactone
- Eplerenone
- Amiloride
Correct answer: Finerenone (non-steroidal MRA)
Finerenone, a non-steroidal mineralocorticoid receptor antagonist, provides additional kidney and cardiovascular protection in CKD with T2DM on top of RAS blockade.
Question 6: Severe non-proliferative diabetic retinopathy follows the '4-2-1 rule.' Which finding triggers the 4-2-1 classification?
- Hemorrhages in 4 quadrants, venous beading in 2 quadrants, or IRMA in 1 quadrant (Correct answer)
- 4 cotton wool spots, 2 hard exudates, 1 new vessel
- Microaneurysms in 4 quadrants only
- 4 disc areas of neovascularization
Correct answer: Hemorrhages in 4 quadrants, venous beading in 2 quadrants, or IRMA in 1 quadrant
The 4-2-1 rule defines severe NPDR: dot/blot hemorrhages in all 4 quadrants, venous beading in ≥2 quadrants, or IRMA in ≥1 quadrant.
Question 7: A diabetic patient with CKD and heart failure is started on dapagliflozin. Which mechanism accounts for its heart failure benefit?
- Osmotic diuresis reducing preload and afterload with direct myocardial effects (Correct answer)
- Increased insulin sensitivity reducing cardiac workload
- ACE inhibitor-like efferent arteriolar dilation
- Reduction in HbA1c lowering cardiac oxidative stress
Correct answer: Osmotic diuresis reducing preload and afterload with direct myocardial effects
SGLT2 inhibitors reduce plasma volume via osmotic diuresis and natriuresis, decrease afterload, and have direct cardioprotective metabolic effects on myocytes.
BC ADM Complications Management 4
A diabetic patient with gastroparesis has erratic postprandial glucose levels.
Which insulin timing strategy is most appropriate?