BC ADM Safety & Risk Management 3 — Questions and Answers
Question 1: A patient with type 1 diabetes reports frequent hypoglycemia unawareness. Which strategy is MOST appropriate to restore hypoglycemia awareness?
- Increase the target HbA1c to allow higher glucose levels for several weeks (Correct answer)
- Immediately switch to an insulin pump
- Add a sulfonylurea to reduce insulin requirements
- Administer glucagon prophylactically at each meal
Correct answer: Increase the target HbA1c to allow higher glucose levels for several weeks
Hypoglycemia unawareness can be reversed by short-term avoidance of hypoglycemia, which resets the glycemic threshold for counter-regulatory responses.
Question 2: Which of the following is the MOST significant risk factor for severe hypoglycemia in patients with long-standing type 1 diabetes?
- Impaired awareness of hypoglycemia (IAH) (Correct answer)
- High carbohydrate diet
- Elevated fasting glucose levels
- Insulin resistance
Correct answer: Impaired awareness of hypoglycemia (IAH)
Impaired awareness of hypoglycemia substantially increases the risk of severe hypoglycemia because patients cannot recognize and treat early warning signs.
Question 3: A patient on insulin therapy is scheduled for a colonoscopy requiring bowel prep. What is the BEST recommendation for insulin management during the prep day?
- Reduce basal insulin by 20–30% and monitor glucose frequently (Correct answer)
- Withhold all insulin until the procedure is completed
- Increase bolus insulin to cover liquid calories
- Continue the usual insulin regimen without adjustment
Correct answer: Reduce basal insulin by 20–30% and monitor glucose frequently
Reduced caloric intake during bowel prep necessitates a modest basal insulin reduction and frequent glucose monitoring to prevent hypoglycemia.
Question 4: Which glucose level threshold is generally used to define clinically significant hypoglycemia requiring intervention according to ADA standards?
- < 54 mg/dL (3.0 mmol/L) (Correct answer)
- < 70 mg/dL (3.9 mmol/L)
- < 80 mg/dL (4.4 mmol/L)
- < 60 mg/dL (3.3 mmol/L)
Correct answer: < 54 mg/dL (3.0 mmol/L)
ADA Level 2 hypoglycemia is defined as glucose < 54 mg/dL and requires immediate treatment regardless of symptoms.
Question 5: A patient with type 2 diabetes and CKD stage 4 is on metformin. What is the MOST appropriate safety action?
- Discontinue metformin due to risk of lactic acidosis (Correct answer)
- Halve the metformin dose and monitor renal function quarterly
- Continue metformin and add an SGLT2 inhibitor
- Switch to a high-dose sulfonylurea for better glycemic control
Correct answer: Discontinue metformin due to risk of lactic acidosis
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² (CKD stage 4) due to the risk of lactic acidosis.
Question 6: Which approach BEST prevents insulin injection site lipohypertrophy?
- Rotate injection sites systematically and change needles with each injection (Correct answer)
- Inject only into the abdomen to ensure consistent absorption
- Reuse needles to reduce patient cost burden
- Use only insulin pen devices rather than syringes
Correct answer: Rotate injection sites systematically and change needles with each injection
Systematic site rotation and using a fresh needle each time prevents the tissue trauma that leads to lipohypertrophy.
Question 7: A patient with type 1 diabetes presents with nausea, vomiting, and glucose of 320 mg/dL with ketones in urine. They are on an insulin pump. What is the MOST critical first safety step?
- Administer a correction dose via injection and change the infusion set immediately (Correct answer)
- Increase the pump basal rate and observe for 2 hours
- Disconnect the pump and delay insulin until vomiting resolves
- Administer oral glucose to prevent pump occlusion
Correct answer: Administer a correction dose via injection and change the infusion set immediately
Pump occlusion is a common cause of DKA in pump users; a subcutaneous injection bypasses the occlusion while set replacement is performed.
BC ADM Safety & Risk Management 3
A patient with type 1 diabetes reports frequent hypoglycemia unawareness.
Which strategy is MOST appropriate to restore hypoglycemia awareness?