BC ADM Medication & Therapeutic Interventions 5

Question 1

A patient with T2DM on basal-bolus insulin therapy presents with the 'dawn phenomenon.' The most targeted intervention is:

Accepted Answer

Increasing the basal insulin dose or timing adjustment to cover early morning cortisol surge

Answer

The dawn phenomenon is caused by early morning counter-regulatory hormone release (GH, cortisol) increasing hepatic glucose output; adjusting basal insulin timing or dose to peak coverage in the early morning hours is the correct approach.

Question 2

Which GLP-1 receptor agonist is approved for once-weekly subcutaneous injection AND has an FDA-approved oral formulation?

Accepted Answer

Semaglutide

Answer

Semaglutide (Ozempic) is available as a once-weekly subcutaneous injection, and oral semaglutide (Rybelsus) is the only FDA-approved oral GLP-1 receptor agonist.

Question 3

A patient develops euglycemic diabetic ketoacidosis (euDKA) while on an SGLT2 inhibitor. Glucose is 178 mg/dL. Which action is most critical?

Accepted Answer

Discontinue the SGLT2 inhibitor and initiate insulin and IV fluids with glucose

Answer

EuDKA requires immediate SGLT2 inhibitor discontinuation followed by insulin and dextrose-containing IV fluids to suppress ketogenesis and restore normal metabolism, even though glucose appears near-normal.

Question 4

When calculating a carbohydrate-to-insulin ratio (CIR) for a patient, the '500 rule' states:

Accepted Answer

500 mg/dL divided by total daily dose equals grams of carb covered per unit

Answer

The 500 rule divides 500 by the total daily insulin dose (TDD) to estimate how many grams of carbohydrate are covered by 1 unit of rapid-acting insulin, guiding meal bolus calculations.

Question 5

A patient with T2DM and heart failure with reduced ejection fraction (HFrEF) is best served by adding which glucose-lowering agent beyond metformin?

Accepted Answer

Dapagliflozin 10 mg daily

Answer

SGLT2 inhibitors like dapagliflozin have demonstrated reduced cardiovascular death and worsening heart failure in HFrEF patients (DAPA-HF trial); TZDs and saxagliptin are contraindicated or associated with increased HF hospitalization.

(BC ADM) Advanced Diabetes Management Certification Practice Test

(BC ADM) Advanced Diabetes Management Certification Practice Test

BC ADM Medication & Therapeutic Interventions 5