CDE Medication Management 4

Question 1

A patient using an insulin pump (CSII) develops hyperglycemia with ketones. What is the most common mechanical cause?

Accepted Answer

Infusion set occlusion or site failure

Answer

Infusion set occlusion or catheter site failure is the most frequent mechanical cause of hyperglycemia with ketone production in pump users because subcutaneous rapid-acting insulin delivery is interrupted.

Question 2

Which statement best describes the Somogyi effect in insulin-treated patients?

Accepted Answer

Morning hyperglycemia caused by rebound from nocturnal hypoglycemia triggering counter-regulatory hormones

Answer

The Somogyi effect (rebound hyperglycemia) occurs when nocturnal hypoglycemia triggers counter-regulatory hormones (glucagon, epinephrine, cortisol) that overshoot and cause morning hyperglycemia.

Question 3

A type 2 diabetes patient with an HbA1c of 9.5% and established atherosclerotic cardiovascular disease is starting medication. According to ADA guidelines, which drug class should be prioritized after metformin?

Accepted Answer

GLP-1 receptor agonist with proven CV benefit

Answer

ADA guidelines recommend GLP-1 receptor agonists or SGLT2 inhibitors with proven cardiovascular benefit as preferred second-line agents in patients with established ASCVD.

Question 4

What is the recommended storage instruction for an insulin pen that is currently in use?

Accepted Answer

Store at room temperature (below 77°F/25°C) for up to 28-30 days

Answer

An insulin pen in use should be stored at room temperature (below 77°F/25°C) for up to 28-30 days depending on the insulin type; refrigerating in-use pens can cause discomfort and is unnecessary.

Question 5

A patient asks about combining exenatide (Byetta) with insulin. Which statement is accurate?

Accepted Answer

Exenatide should not be used with mealtime insulin due to additive hypoglycemia risk without clear benefit evidence

Answer

Exenatide should not be combined with prandial insulin as this increases hypoglycemia risk; basal insulin combinations with GLP-1 RAs (e.g., Xultophy, Soliqua) are approved but not mixing in the same syringe.

Certified Diabetes Educator Test Practice Test

Certified Diabetes Educator Test Practice Test

CDE Medication Management 4