BC ADM Safety & Risk Management 5 — Questions and Answers
Question 1: Which intervention has the STRONGEST evidence for reducing the risk of cardiovascular events in a patient with type 2 diabetes and established atherosclerotic cardiovascular disease?
- Adding an SGLT2 inhibitor or GLP-1 receptor agonist with proven cardiovascular benefit (Correct answer)
- Intensifying statin therapy to achieve LDL < 50 mg/dL
- Targeting HbA1c < 6.0% to minimize glucose toxicity
- Adding aspirin 325 mg daily regardless of bleeding risk
Correct answer: Adding an SGLT2 inhibitor or GLP-1 receptor agonist with proven cardiovascular benefit
Guidelines prioritize SGLT2 inhibitors and GLP-1 receptor agonists with demonstrated MACE reduction as second-line agents in patients with established ASCVD.
Question 2: A patient with type 1 diabetes is preparing for vigorous aerobic exercise lasting 60 minutes. Which strategy BEST reduces the risk of exercise-induced hypoglycemia?
- Reduce the pre-exercise bolus insulin by 25–50% and consume 15–30g of carbohydrates if glucose is < 126 mg/dL (Correct answer)
- Take an extra dose of rapid-acting insulin 30 minutes before exercise to offset glucose uptake
- Skip the pre-exercise meal entirely to keep glucose stable during exercise
- Increase the basal rate on the insulin pump 2 hours after exercise ends
Correct answer: Reduce the pre-exercise bolus insulin by 25–50% and consume 15–30g of carbohydrates if glucose is < 126 mg/dL
Aerobic exercise increases insulin sensitivity and muscle glucose uptake, necessitating pre-exercise bolus reduction and carbohydrate supplementation when starting glucose is low.
Question 3: A patient using a flash glucose monitor reports frequent alarms for hypoglycemia overnight but denies symptoms. What is the MOST important safety step?
- Confirm overnight hypoglycemia with fingerstick checks and evaluate insulin regimen for adjustment (Correct answer)
- Disable overnight alarms to improve sleep quality
- Immediately double the bedtime snack without checking glucose
- Assume sensor error and continue the current regimen
Correct answer: Confirm overnight hypoglycemia with fingerstick checks and evaluate insulin regimen for adjustment
Asymptomatic overnight hypoglycemia confirmed by fingerstick indicates a true safety risk requiring insulin dose adjustment, not alarm suppression.
Question 4: Which of the following best describes the 'Rule of 15' for treating mild-to-moderate hypoglycemia?
- Consume 15g of fast-acting carbohydrates, wait 15 minutes, recheck glucose, and repeat if still < 70 mg/dL (Correct answer)
- Consume 15g of protein, wait 15 minutes, then eat a full meal
- Administer 15 units of glucagon and call emergency services after 15 minutes
- Consume 15 crackers, recheck in 30 minutes, and repeat once if needed
Correct answer: Consume 15g of fast-acting carbohydrates, wait 15 minutes, recheck glucose, and repeat if still < 70 mg/dL
The Rule of 15 recommends 15g of fast-acting carbohydrate, a 15-minute wait, and rechecking glucose to guide retreatment.
Question 5: What is the PRIMARY reason to avoid tight glycemic control (HbA1c < 6.5%) in elderly patients with multiple comorbidities?
- Increased risk of severe hypoglycemia, falls, and cardiovascular events outweighs benefits in this population (Correct answer)
- Elderly patients cannot absorb insulin effectively at low glucose targets
- Tight control causes accelerated kidney function decline in older adults
- Sulfonylureas required for tight control are contraindicated over age 70
Correct answer: Increased risk of severe hypoglycemia, falls, and cardiovascular events outweighs benefits in this population
The ACCORD trial and geriatric guidelines establish that tight control increases hypoglycemia risk, which in the elderly leads to falls, fractures, arrhythmias, and death.
Question 6: A patient with type 2 diabetes who is pregnant presents with fasting glucose of 108 mg/dL. Which pharmacologic agent is SAFEST during the first trimester?
- Insulin, as it does not cross the placenta and is the preferred agent in pregnancy (Correct answer)
- Metformin, as it is FDA category B and freely available
- Glipizide, as it has the lowest risk of neonatal hypoglycemia
- Sitagliptin, as it has the most extensive pregnancy safety data
Correct answer: Insulin, as it does not cross the placenta and is the preferred agent in pregnancy
Insulin is the preferred pharmacologic treatment for diabetes in pregnancy because it does not cross the placenta and has the longest safety record.
Question 7: Which monitoring parameter is MOST critical when initiating an ACE inhibitor in a patient with diabetic nephropathy?
- Serum creatinine and potassium within 1–2 weeks of initiation (Correct answer)
- Fasting glucose levels to detect ACE inhibitor–induced hypoglycemia
- Urine albumin-to-creatinine ratio monthly for the first 3 months
- Blood pressure measured hourly for the first 24 hours
Correct answer: Serum creatinine and potassium within 1–2 weeks of initiation
ACE inhibitors can cause an acute rise in creatinine (especially with renal artery stenosis) and hyperkalemia, both of which must be checked within 1–2 weeks of starting therapy.
BC ADM Safety & Risk Management 5
Which intervention has the STRONGEST evidence for reducing the risk of cardiovascular events in a patient with type 2 diabetes and established atherosclerotic cardiovascular disease?