BC ADM Safety & Risk Management 4 — Questions and Answers
Question 1: A patient with type 2 diabetes and heart failure is being considered for an SGLT2 inhibitor. Which safety concern requires evaluation BEFORE initiating therapy?
- eGFR below 20 mL/min/1.73 m², which may limit efficacy and safety (Correct answer)
- Risk of hypoglycemia when combined with lifestyle modifications
- Potential for weight gain worsening heart failure symptoms
- Increased risk of lactic acidosis in cardiac patients
Correct answer: eGFR below 20 mL/min/1.73 m², which may limit efficacy and safety
SGLT2 inhibitors lose glycemic efficacy at very low eGFR and carry risks of volume depletion and genitourinary infections that must be weighed against cardiovascular benefits.
Question 2: Which patient scenario represents the HIGHEST risk for glucagon kit failure in an emergency?
- The patient's glucagon kit has expired and caregivers have not received training (Correct answer)
- The patient is on a basal-bolus insulin regimen
- The patient has frequent mild hypoglycemia requiring juice
- The patient uses continuous glucose monitoring
Correct answer: The patient's glucagon kit has expired and caregivers have not received training
An expired kit combined with untrained caregivers represents a compounding safety failure that could result in a fatal hypoglycemic event.
Question 3: When counseling a patient with diabetes about sick-day management, which instruction is MOST important regarding insulin?
- Never stop taking insulin even if not eating, as illness raises glucose and increases insulin demand (Correct answer)
- Skip insulin doses when vomiting to avoid hypoglycemia
- Double basal insulin during illness to prevent DKA
- Use only sliding-scale insulin during illness to simplify management
Correct answer: Never stop taking insulin even if not eating, as illness raises glucose and increases insulin demand
Counter-regulatory hormones released during illness increase glucose and can precipitate DKA, so insulin should never be withheld even when oral intake is reduced.
Question 4: A patient reports driving long distances and using CGM for glucose monitoring. What safety recommendation is MOST appropriate?
- Confirm glucose ≥ 90 mg/dL with a fingerstick before driving and every 2 hours on long trips (Correct answer)
- CGM readings alone are sufficient for all driving safety decisions
- Stop driving only if symptomatic hypoglycemia occurs
- Consume 30g carbohydrates before every drive regardless of glucose level
Correct answer: Confirm glucose ≥ 90 mg/dL with a fingerstick before driving and every 2 hours on long trips
CGM can have calibration lag, so fingerstick confirmation before driving is recommended; glucose should be above 90 mg/dL to provide a safety buffer.
Question 5: Which complication is MOST associated with prolonged undetected hyperglycemia in a patient using an insulin pump?
- Diabetic ketoacidosis due to subcutaneous infusion set occlusion (Correct answer)
- Severe hypoglycemia from excess insulin delivery
- Hyponatremia from polyuria-driven fluid shifts
- Hyperkalemia from insulin deficiency
Correct answer: Diabetic ketoacidosis due to subcutaneous infusion set occlusion
Pump users receive only rapid-acting insulin; an occlusion eliminates all insulin delivery and rapidly leads to DKA within hours.
Question 6: A hospitalized patient with diabetes is transitioned from an IV insulin infusion to subcutaneous insulin. When should the first subcutaneous dose be given relative to discontinuing the infusion?
- Administer subcutaneous basal insulin 1–2 hours before stopping the infusion (Correct answer)
- Stop the infusion, then give subcutaneous insulin immediately after
- Wait 4 hours after stopping the infusion before giving any subcutaneous insulin
- Give subcutaneous insulin 6 hours before stopping the infusion
Correct answer: Administer subcutaneous basal insulin 1–2 hours before stopping the infusion
Subcutaneous basal insulin requires 1–2 hours to begin working, so it must overlap with the IV infusion to prevent a gap in insulin coverage and rebound hyperglycemia.
Question 7: Which of the following medications used in diabetes management carries a Black Box Warning for risk of lower limb amputation?
- Canagliflozin (Invokana) (Correct answer)
- Liraglutide (Victoza)
- Sitagliptin (Januvia)
- Pioglitazone (Actos)
Correct answer: Canagliflozin (Invokana)
Canagliflozin carries an FDA Black Box Warning for increased risk of lower limb amputations, primarily at the toe and midfoot level.
BC ADM Safety & Risk Management 4
A patient with type 2 diabetes and heart failure is being considered for an SGLT2 inhibitor.
Which safety concern requires evaluation BEFORE initiating therapy?