Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90 percent of Type 1 diabetics have:

A. Autoantibodies to two tyrosine phosphatases

B. Mutation of the hepatic transcription factor on chromosome 12

C. A defective glucokinase molecule due to a defective gene on chromosome 7p

D. Mutation of the insulin promoter factor

A. Autoantibodies to two tyrosine phosphatases

Type 2 diabetes is a complex disorder involving:

A. Absence of insulin production by the beta cells

B. A suboptimal response of insulin-sensitive tissues in the liver

C. Increased levels of glucagon-like peptide in the post-prandial period

D. Too much fat uptake in the intestine

B. A suboptimal response of insulin-sensitive tissues in the liver

Diagnostic criteria for diabetes include:

A. Fasting blood glucose greater than 140 mg/dl on two occasions

B. Post-prandial blood glucose greater than 140 mg/dl

C. Fasting blood glucose 100 to 125 mg/dl on two occasions

D. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl

D. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl

Routine screening of asymptomatic adults for diabetes is appropriate for:

A. Individuals who are older than 45 and have a BMI less than 25 kg/m2

B. Native Americans, African Americans, and Hispanics

C. Persons with HDL cholesterol greater than 100 mg/dl

D. Persons with pre-diabetes confirmed on at least two occasions

B. Native Americans, African Americans, and Hispanics

Screening criteria for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter:

A. BMI above the 85th percentile for age and sex

B. Family history of diabetes in first- or second-degree relative

C. Hypertension based on criteria for children

D. Any of the above

D. Any of the above

Insulin is used to treat both types of diabetes. It acts by:

A. Increasing beta cell response to low blood glucose levels

B. Stimulating hepatic glucose production

C. Increasing peripheral glucose uptake by skeletal muscle and fat

D. Improving the circulation of free fatty acids

C. Increasing peripheral glucose uptake by skeletal muscle and fat

Adam has Type 1 diabetes and plays tennis for his university. He exhibits a Knowledge deficit about his insulin and his diagnosis. He should be taught that:

A. He should increase his CHO intake during times of exercise

B. Each brand of insulin is equal in bioavailability, so buy the least expensive

C. Alcohol produces hypoglycemia and can help control his diabetes when taken insmall amounts

D. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes

A. He should increase his CHO intake during times of exercise

Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous inject. Which of the following insulin preparations has the shortest onset and duration of action?

A. Insulin lispro

B. Insulin glulisine

C. Insulin glargine

D. Insulin detemir

B. Insulin glulisine

The drug of choice for Type 2 diabetics is metformin. Metformin:

A. Decreases glycogenolysis by the liver

B. Increases the release of insulin from beta cells

C. Increases intestinal uptake of glucose

D. Prevents weight gain associated with hyperglycemia

A. Decreases glycogenolysis by the liver

Before prescribing metformin, the provider should:

A. Draw a serum creatinine level to assess renal function

B. Try the patient on insulin

C. Prescribe a thyroid preparation if the patient needs to lose weight

D. All of the above

A. Draw a serum creatinine level to assess renal function

Sulfonylureas may be added to a treatment regimen for Type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:

A. Increase endogenous insulin secretion

B. Have a significant risk for hypoglycemia

C. Address the insulin resistance found in Type 2 diabetics

D. Improve insulin binding to receptors

B. Have a significant risk for hypoglycemia

Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:

A. Better reduction in glucose levels than other classes

B. Less weight gain than sulfonylureas

C. Low risk for hypoglycemia

D. Can be given twice daily

C. Low risk for hypoglycemia

Control targets for patients with diabetes include:

A. HbA1C between 7 and 8

B. Fasting blood glucose levels between 100 and 120 mg/dl

C. Blood pressure less than 130/80 mm Hg

D. LDL lipids less than 130 mg/dl

C. Blood pressure less than 130/80 mm Hg

Establishing glycemic targets is the first step in treatment of both types of diabetes. For Type 1 diabetes:

A. Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily

B. Tight control is acceptable for older adults if they are without complications

C. Plasma glucose levels are the same for children as adults

D. Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl

D. Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl

Treatment with insulin for Type 1 diabetics:

A. Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight

B. Divides the total doses into three injections based on meal size

C. Uses a total daily dose of insulin glargine given once daily with no other insulin required

D. Is based on the level of blood glucose

A. Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight

When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?

A. Give two-thirds of the total dose in the morning and one-third in the evening.

B. Give 0.3 units per kg of premixed 70/30 insulin with one-third in the morning and two-thirds in the evening.

C. Give 50% of an insulin glargine dose in the morning and 50% in the evening.

D. Give long-acting insulin in the morning and short-acting insulin at bedtime.

A. Give two-thirds of the total dose in the morning and one-third in the evening.

Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include:

A. Those with long-standing diabetes

B. Older adults

C. Those with no significant cardiovascular disease

D. Young children who are early in their disease

C. Those with no significant cardiovascular disease

Prevention of conversion from pre-diabetes to diabetes in young children must take highest priority and should focus on:

A. Aggressive dietary manipulation to prevent obesity

B. Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease

C. Maintaining a blood pressure that is less than 80% based on weight and height to prevent hypertension

D. All of the above

B. Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease

The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:

A. Metformin and insulin

B. Sulfonylureas and insulin glargine

C. Split-mixed dose insulin and GPL-1 agonists

D. Biguanides and insulin lispro

A. Metformin and insulin

Unlike most Type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is:

A. Weight loss in previously overweight persons

B. Involuntary loss of 10% of body weight in less than 6 months

C. Decline in lean body mass over a 12-month period

D. Increase in central versus peripheral body adiposity

B. Involuntary loss of 10% of body weight in less than 6 months

The drugs recommended for older adults with Type 2 diabetes include:

A. Second generation sulfonylureas

B. Metformin

C. Pioglitazone

D. Third generation sulfonylureas

D. Third generation sulfonylureas

Ethnic groups differ in their risk for and presentation of diabetes. Hispanics:

A. Have a high incidence of obesity, elevated triglycerides, and hypertension

B. Do best with drugs that foster weight loss, such as metformin

C. Both A and B

D. Neither A nor B

C. Both A and B

The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include:

A. Glycemic targets between 7% and 7.5%

B. Use of insulin in Type 2 diabetics

C. Control of hypertension and hyperlipidemia

D. Stopping smoking

A. Glycemic targets between 7% and 7.5%

All diabetic patients with known cardiovascular disease should be treated with:

A. Beta blockers to prevent MIs

B. ACE inhibitors and aspirin to reduce risk of cardiovascular events

C. Sulfonylureas to decrease cardiovascular mortality

D. Pioglitazone to decrease atherosclerotic plaque buildup

B. ACE inhibitors and aspirin to reduce risk of cardiovascular events

All diabetic patients with hyperlipidemia should be treated with:

A. HMG-CoA reductase inhibitors

B. Fibric acid derivatives

C. Nicotinic acid

D. Colestipol

A. HMG-CoA reductase inhibitors

Both ACE inhibitors and some Angiotensin-II receptor blockers have been approved in treating:

A. Hypertension in diabetic patients

B. Diabetic nephropathy

C. Both A and B

D. Neither A nor B

C. Both A and B

Protein restriction helps slow the progression of albuminuria, GFR decline, and ESRD is some patients with diabetes. It is useful for patients who:

A. Cannot tolerate ACE inhibitors or ARBs

B. Have uncontrolled hypertension

C. Have HbA1C levels above 7%

D. Show progression of diabetic nephropathy despite optimal glucose and blood pressure control

D. Show progression of diabetic nephropathy despite optimal glucose and blood pressure control

Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include:

A. Resting tachycardia, exercise intolerance, and orthostatic hypotension

B. Gastroparesis, cold intolerance, and moist skin

C. Hyperglycemia, erectile dysfunction, and deficiency of free fatty acids

D. Pain, loss of sensation, and muscle weakness

A. Resting tachycardia, exercise intolerance, and orthostatic hypotension

Drugs used to treat diabetic peripheral neuropathy include:

A. Metoclopramide

B. Cholinergic agonists

C. Cardioselective beta blockers

D. Gabapentin

D. Gabapentin

The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes?

A. Fasting blood glucose

B. HbA1C

C. Thyroid function tests

D. Electrocardiograms

B. HbA1C