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CME/CE: DiabetesPharmacology: Insulin Therapy • NPPA21Questions1. Which of the followingstatements is true regarding type 2diabetes mellitus (T2DM)?a. The core defect associated withT2DM is autoimmune beta celldestruction and genetic mutation.b. T2DM is a progressive disorder,requiring the eventual use of insulinin most cases.c. The glucotoxicity associated withT2DM causes little damage to thebeta cells.d. Approximately 75% of betacell destruction has occurred atdiagnosis of T2DM.2. All but which one of the following isa common cause of delay in initiatinginsulin for people with T2DM?a. Clinician inertiab. Fear of weight gain, hypoglycemiaand use of needlesc. Sense of personal failure for thepatientd. Inability of the patient to manipulateinsulin pens and needles3. Which patient represents thebest circumstances for consideringintensive glycemic management?a. Frail 84-year-old man with manycomorbiditiesb. 50-year-old woman who is notaware when she has hypoglycemiac. 28-year-old woman with type1 diabetes for 11 yearsd. 38-year-old man with newlydiagnosed terminal cancer4. Which of the following is arecommended method for initiatinginsulin for a patient?a. Add 0.15 units/kg/day of longactinginsulin once daily.b. Add 5 units of rapid-acting insulinbefore each meal.c. Add 10 units of rapid-acting insulinbefore bedtime.d. Add 20 units of NPH at breakfast.5. What is the primary advantage ofusing biphased insulin?a. It is only given once daily.b. It is easy to titrate with greatprecision.c. It is given twice daily, eliminatingthe need for midday coverage.d. It is given at bedtime and will lastfor up to 24 hours.6. After starting long-acting insulin,it is best to discontinue which one ofthe following medications due to therisk of hypoglycemia?a. Thiazolidinedionesb. Sulfonylureasc. Biguanidesd. Incretin mimetics7. Which one of these is an easyand safe titration algorithm foradjusting basal insulin?a. Increase dose by 2 units everythird day for fasting glucose levels> 130 md/dL.b. Increase dose by 4 units everyother day for fasting glucose levels >110 mg/dL.c. Decrease dose by 15% for fastingglucose levels < 100 mg/dL.d. Decrease dose by 5% for fastingglucose levels < 50 mg/dL.8. When should prandial insulincoverage be started for a patient onlong-acting basal insulin?a. When the basal dose exceeds 0.5units/kg/dayb. When the basal dose exceeds1 unit/kg/dayc. When the basal dose is greaterthan 50 units a dayd. When the basal dose is equal to20 units a day9. What is the primary advantageof rapid-acting analog insulin overregular insulin?a. Analog insulin is less expensive.b. Analog insulin is absorbed lesspredictably than NPH insulin.c. Analog insulin is absorbed moreslowly and lingers for an extended time.d. Analog insulin more closely mimicsphysiologic insulin secretion.10. Which one of the followingshould be emphasized with patientswhen insulin is initiated?a. Severe hypoglycemia is a threatonly with basal insulin coverage.b. All insulin must be refrigerated forthe entire time of use.c. Carry a source of glucose like hardcandy at all times.d. Basal insulin can be given at differingtimes of the day during the week.Evaluation1. The educational objectives wereachieved.a. strongly disagreeb. disagreec. neutrald. agreee. strongly agree2. Based on what you learned inthis article, will you make changesin your practice?a. yesb. noIf yes, please describe the changesyou intend to make: ____________________________________________What barriers to change do youanticipate? _____________________________________________________What strategies or mechanisms willyou apply to overcome these barriers?______________________________________________________________4. The information in the articlewas fair, balanced, free ofcommercial bias and supported byscientific evidence.a. yesb. noIf no, describe the nature of the issue:_______________________________Registration & Answer FormThis activity has been planned and implemented in accordance with the Essential Areasand policies of the Accreditation Council for Continuing Medical Education through thejoint sponsorship of Wayne State University School of Medicine and ADVANCE for NPs& PAs. The Wayne State University School of Medicine is accredited by the ACCME toprovide continuing medical education for physicians.The Wayne State University School of Medicine designates this educational activityfor a maximum of 1 AMA PRA Category 1 Credit(s). Physicians should only claim creditcommensurate with the extent of their participation in the activity.This activity also is approved for 2 CE contact hours. The issuer of CE contact hoursis Merion Publications (a division of Merion Matters), which is approved as a provider ofcontinuing education in nursing by three agencies. For details on CE provider numbers,visit the CE Test Center on our website, www.advanceweb.com/NPPA.Physician Assistant Instructions:To obtain CME credit, send the completed answer form and registrant information toWayne State University School of Medicine, Attn PA, University Health Center 9A, 4201Saint Antoine St., Detroit, MI 48201. Include a check for $10 payable to Wayne StateUniversity. Or fax the completed form and credit card information to (313) 577-7554.Note: Discover and American Express NOT accepted. Test takers who earn a passingscore will receive a CME certificate by mail, or if paying online can receive an onlinetranscript once registered at http://www.med.wayne.edu/cme/calendarTran.html. Forquestions about CME, call Wayne State University at (313) 577-1453. CME form mustbe postmarked or received within 6 months of the last day of the month of this issue.Nurse Practitioner Instructions:To obtain CE contact hours, take this test online at www.advanceweb.com/NPPA andreceive instant test results and a printable CE certificate upon passage. Or fax thecompleted form and credit card information to (610) 278-1426. Or send the completedanswer form and registrant information to Merion Matters CE Program for NPs, 2900Horizon Dr., King of Prussia, PA 19406. Include a check for $10 payable to MerionMatters. This activity is eligible for CE credit for 2 calendar years after publication.Pharmacology: Insulin Therapy may 2012Test NPPA21EvaluationA B C D A B C D A B C D E1.2.3.4.5.6.7.8.9.10.1.2.3.4.Registrant Information (Please print)Subscriber No. (see mailing label) ____ ____ ____ ____ ____ ____ ____ ____ ____Required for Florida NPs: License No. ___________________________________________E-mail Address ______________________________________________________________Name ______________________________________________________________________Address ❏ Work ❏ Home ___________________________________________________City ____________________________________ State ______ Zip Code _______________Phone No. ❏ Work ❏ Home _________________________________________________Payment: $10❏ For PAs: Check Payable to Wayne State University❏ For NPs: Check Payable to Merion Matters❏ For PAs or NPs: Credit Card No. ________________________ Exp. Date___________Cardholder Name ________________________________________________________Signature _______________________________________________________________❏ American Express (NPs only) ❏ Visa ❏ MasterCard ❏ Discover (NPs only)Statement of CompletionI attest to having completed the CME/CE activity.Signature _____________________________________________ Date _________________Profession ❏ Nurse Practitioner ❏ Physician AssistantADVANCE for NPs & PAs27