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CDE Diabetes

Practice Exam: Glycemic Management in Adults with Type 1 Diabetes (Chapter 12)

Effective management of Type 1 diabetes requires a complex balance of insulin replacement, monitoring, and lifestyle adaptation. This exam tests your understanding of the Diabetes Canada Clinical Practice Guidelines regarding insulin pharmacotherapy, delivery systems, and the prevention of hypoglycemia.

Key Concepts Covered in This Exam:

  • Insulin Regimens: Differentiating between basal-bolus injection therapy and continuous subcutaneous insulin infusion (CSII), and understanding why these are the preferred standards of care.
  • Pharmacotherapy: Identifying the advantages of long-acting analogues (glargine, detemir, degludec) over NPH for reducing nocturnal hypoglycemia , and the role of rapid-acting analogues.
  • Hypoglycemia Prevention: Recognizing strategies for patients with hypoglycemia unawareness, including the use of sensor-augmented pumps (SAP) and standardized education programs.
  • Technology Integration: Understanding the indications for Real-Time Continuous Glucose Monitoring (rtCGM) to improve A1C and reduce severe hypoglycemia.
  • Adjunctive Therapies: Knowing the current limitations and risks (e.g., DKA) associated with non-insulin agents like SGLT2 inhibitors and GLP-1 receptor agonists in Type 1 diabetes.

1. According to the DCCT, what percentage of participants in the intensive treatment group experienced at least one episode of severe hypoglycemia?

2. What is the approximate A1C reduction benefit of CGM compared to CBG in people with baseline A1C >7.0%?

3. Case: A patient with type 1 diabetes on NPH-based basal-bolus therapy experiences frequent nocturnal hypoglycemia. According to the guidelines, which insulin change should be considered?

4. Case: A patient with type 1 diabetes is starting exercise. According to the guidelines, what effect does low- to moderate-intensity exercise have on blood glucose?

5. According to the guidelines, what is the recommended frequency of evaluation for patients on CSII therapy?

6. According to the guidelines, what effect does high-intensity exercise have on blood glucose in type 1 diabetes?

7. According to the evidence, what factor is associated with the greatest A1C benefit from CGM?

8. According to the guidelines, when may faster-acting insulin aspart be administered after the start of a meal?

9. According to the evidence, what are the benefits of insulin degludec compared to insulin glargine U-100?

10. Case: A patient with type 1 diabetes has an A1C at target but wants to use CGM. According to the evidence, what benefit can be expected even with baseline A1C <7.0%?

11. According to the guidelines, what are the preferred insulin management regimens for adults with type 1 diabetes?

12. Case: A patient with type 1 diabetes using CSII and CGM experiences nocturnal hypoglycemia. According to the guidelines, what technology feature may help?

13. According to the meta-analyses, what is the A1C reduction benefit of CSII compared to basal-bolus injection therapy in adults?

14. Case: A patient with type 1 diabetes is considering switching from insulin glargine U-100 to glargine U-300. What should the educator explain about dosing?

15. Case: A diabetes educator is counselling a patient newly diagnosed with type 1 diabetes about the ‘honeymoon period.’ What should the patient understand about this phase?

16. According to the studies on metformin as adjunctive therapy in type 1 diabetes, what effects have been demonstrated?

17. According to the guidelines, what is the medical indication for CSII therapy in patients not achieving glycemic targets despite optimized basal-bolus injection therapy?

18. Case: A patient with type 1 diabetes has impaired hypoglycemia awareness. According to the guidelines, which strategies may reduce hypoglycemia risk?

19. Case: A diabetes care team is evaluating a patient for CSII therapy. According to the guidelines, what characteristics should an appropriate candidate have?

20. When should short-acting regular insulin be administered before the start of a meal?

21. Case: A diabetes educator is teaching a patient about insulin glulisine use in CSII. How often should the infusion set and reservoir be changed according to the product indication?

22. Case: A patient asks about using SGLT2 inhibitors for their type 1 diabetes. According to the guidelines, what is the concern with this class in type 1 diabetes?

23. What is the duration of action of insulin glargine U-300?

24. According to the guidelines, what percentage of hypoglycemic episodes are accounted for by lifestyle factors and changes from usual self-management behaviours?

25. Case: A patient with type 1 diabetes on basal-bolus injection therapy has a bedtime blood glucose of 5.5 mmol/L and is using NPH as basal insulin. What should be recommended to prevent nocturnal hypoglycemia?

26. What is the duration of action of insulin degludec?

27. When should rapid-acting insulin analogues (insulin aspart, glulisine, and lispro) be administered in relation to meals?

28. According to the evidence on liraglutide as add-on therapy in type 1 diabetes, what outcomes have been demonstrated?

29. Case: A patient asks about the difference between biosimilar insulin glargine and the original glargine. According to the guidelines, what should the educator explain?

30. According to the guidelines, which rapid-acting insulin analogues are approved for use in CSII therapy?