Question 1
A 10-year-old child with newly diagnosed type 1 diabetes is being discharged from the
hospital. Which of the following components is most critical to include in the initial
outpatient diabetes management plan to reduce the risk of diabetic ketoacidosis (DKA) and
hospital readmission?
A. Initiate basal insulin therapy and MNT instruction, with follow-up in two weeks.
B. Provide basic carbohydrate counting and bolus insulin instruction with a follow-up
appointment within 30 days.
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
D. Prescribe continuous glucose monitoring (CGM) and glucagon rescue medication and ask
family to schedule a follow-up appointment after the sensor is delivered and set up.
ANSWER
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
Rationale:
For a newly diagnosed 10-year-old with type 1 diabetes, early outpatient management is
critical to prevent DKA and readmission. The most important elements include:
Timely follow-up with a pediatric endocrinologist or diabetes care team within 1 week,
which is recommended by the American Diabetes Association (ADA) and ISPAD guidelines.
Clear education on recognizing and managing glucose emergencies (hypoglycemia and
hyperglycemia), which empowers families to intervene early and avoid complications.
While insulin initiation, nutrition therapy, carbohydrate counting, CGM, and glucagon
prescription are also important, none of the other choices provide both timely follow-up
and emergency management guidance, which are the most essential components for
immediate safety and stabilization.
1
,❌ Why the other options are less appropriate:
A: Two-week follow-up is too delayed, and focusing only on basal insulin omits bolus
insulin, which is vital for type 1 diabetes.
B: A 30-day follow-up is much too long; it significantly increases the risk of DKA and
complications.
D: While CGM and glucagon are important tools, waiting for CGM setup before follow-up
delays care and does not prioritize immediate emergency education or timely specialist
evaluation.
Question 2
Which medication class(es) place asymptomatic people at increased risk of developing
hyperglycemia?
A. Atypical antipsychotics
B. Glucocorticoids
C. Aspirin
D. Both A and B
ANSWER
D. Both A and B
Rationale:
✅ Atypical Antipsychotics
Examples: Olanzapine, Risperidone, Quetiapine
Can cause insulin resistance, weight gain, and impaired glucose metabolism
Associated with new-onset diabetes and worsening of existing hyperglycemia
✅ Glucocorticoids
Examples: Prednisone, Dexamethasone
Increase hepatic glucose production and peripheral insulin resistance
2
,Often cause transient or persistent hyperglycemia, especially in people with prediabetes
or other risk factors
❌ Aspirin
Does not cause hyperglycemia
In fact, low-dose aspirin has sometimes been studied for its potential protective effects in
cardiovascular health for people with diabetes, but it does not affect glucose metabolism
directly
Question 3
A person living with diabetes newly diagnosed with type 2 diabetes is started on metformin,
metformin should be titrated to minimize which side effect?
A. Rebound hyperglycemia
B. Reactive hypoglycemia
C. Weight gain
D. Gastrointestinal-side effects
ANSWER
D. Gastrointestinal-side effects
Rationale:
Metformin is the first-line medication for type 2 diabetes and is generally well tolerated,
but gastrointestinal (GI) side effects are the most common issue, especially during
initiation.
✅ GI side effects include: Nausea, Diarrhea, Abdominal discomfort, Bloating
To reduce these side effects, metformin is typically titrated slowly—starting at a low dose
(e.g., 500 mg once daily) and gradually increasing over 1-2 weeks.
❌ Why the other options are incorrect:
A. Rebound hyperglycemia: Metformin does not cause rebound hyperglycemia.
3
, B. Reactive hypoglycemia: Metformin does not cause hypoglycemia, especially when used
alone.
C. Weight gain: Metformin is usually weight-neutral or may cause modest weight loss, not
gain.
Question 4
A person living with diabetes is currently taking metformin, Glyburide and an evening basal
dose of insulin. After discussing how best to achieve better glycemic control, he has agreed
to add a pre-meal insulin dose. which modification should be made with addition of the
prandial dose?
A. discontinue the glyburide
B. discontinue the metformin
C. No modification should be made
D. discontinue the metformin, glyburide, and evening insulin
ANSWER
A. discontinue the glyburide
Explanation:
When prandial (mealtime) insulin is added to a regimen that already includes basal
insulin, it is appropriate to discontinue sulfonylureas like glyburide for several reasons:
✅ Why discontinue glyburide:
Redundant mechanism: Sulfonylureas stimulate insulin secretion. Once rapid-acting insulin
is given before meals, glyburide becomes unnecessary.
Increased risk of hypoglycemia: Combining glyburide with both basal and bolus insulin
significantly increases the risk of low blood sugar.
No added benefit: There's limited additional glycemic benefit when using sulfonylureas
alongside a full insulin regimen.
✅ Continue metformin:
Metformin helps reduce insulin resistance and does not cause hypoglycemia.
4
A 10-year-old child with newly diagnosed type 1 diabetes is being discharged from the
hospital. Which of the following components is most critical to include in the initial
outpatient diabetes management plan to reduce the risk of diabetic ketoacidosis (DKA) and
hospital readmission?
A. Initiate basal insulin therapy and MNT instruction, with follow-up in two weeks.
B. Provide basic carbohydrate counting and bolus insulin instruction with a follow-up
appointment within 30 days.
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
D. Prescribe continuous glucose monitoring (CGM) and glucagon rescue medication and ask
family to schedule a follow-up appointment after the sensor is delivered and set up.
ANSWER
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
Rationale:
For a newly diagnosed 10-year-old with type 1 diabetes, early outpatient management is
critical to prevent DKA and readmission. The most important elements include:
Timely follow-up with a pediatric endocrinologist or diabetes care team within 1 week,
which is recommended by the American Diabetes Association (ADA) and ISPAD guidelines.
Clear education on recognizing and managing glucose emergencies (hypoglycemia and
hyperglycemia), which empowers families to intervene early and avoid complications.
While insulin initiation, nutrition therapy, carbohydrate counting, CGM, and glucagon
prescription are also important, none of the other choices provide both timely follow-up
and emergency management guidance, which are the most essential components for
immediate safety and stabilization.
1
,❌ Why the other options are less appropriate:
A: Two-week follow-up is too delayed, and focusing only on basal insulin omits bolus
insulin, which is vital for type 1 diabetes.
B: A 30-day follow-up is much too long; it significantly increases the risk of DKA and
complications.
D: While CGM and glucagon are important tools, waiting for CGM setup before follow-up
delays care and does not prioritize immediate emergency education or timely specialist
evaluation.
Question 2
Which medication class(es) place asymptomatic people at increased risk of developing
hyperglycemia?
A. Atypical antipsychotics
B. Glucocorticoids
C. Aspirin
D. Both A and B
ANSWER
D. Both A and B
Rationale:
✅ Atypical Antipsychotics
Examples: Olanzapine, Risperidone, Quetiapine
Can cause insulin resistance, weight gain, and impaired glucose metabolism
Associated with new-onset diabetes and worsening of existing hyperglycemia
✅ Glucocorticoids
Examples: Prednisone, Dexamethasone
Increase hepatic glucose production and peripheral insulin resistance
2
,Often cause transient or persistent hyperglycemia, especially in people with prediabetes
or other risk factors
❌ Aspirin
Does not cause hyperglycemia
In fact, low-dose aspirin has sometimes been studied for its potential protective effects in
cardiovascular health for people with diabetes, but it does not affect glucose metabolism
directly
Question 3
A person living with diabetes newly diagnosed with type 2 diabetes is started on metformin,
metformin should be titrated to minimize which side effect?
A. Rebound hyperglycemia
B. Reactive hypoglycemia
C. Weight gain
D. Gastrointestinal-side effects
ANSWER
D. Gastrointestinal-side effects
Rationale:
Metformin is the first-line medication for type 2 diabetes and is generally well tolerated,
but gastrointestinal (GI) side effects are the most common issue, especially during
initiation.
✅ GI side effects include: Nausea, Diarrhea, Abdominal discomfort, Bloating
To reduce these side effects, metformin is typically titrated slowly—starting at a low dose
(e.g., 500 mg once daily) and gradually increasing over 1-2 weeks.
❌ Why the other options are incorrect:
A. Rebound hyperglycemia: Metformin does not cause rebound hyperglycemia.
3
, B. Reactive hypoglycemia: Metformin does not cause hypoglycemia, especially when used
alone.
C. Weight gain: Metformin is usually weight-neutral or may cause modest weight loss, not
gain.
Question 4
A person living with diabetes is currently taking metformin, Glyburide and an evening basal
dose of insulin. After discussing how best to achieve better glycemic control, he has agreed
to add a pre-meal insulin dose. which modification should be made with addition of the
prandial dose?
A. discontinue the glyburide
B. discontinue the metformin
C. No modification should be made
D. discontinue the metformin, glyburide, and evening insulin
ANSWER
A. discontinue the glyburide
Explanation:
When prandial (mealtime) insulin is added to a regimen that already includes basal
insulin, it is appropriate to discontinue sulfonylureas like glyburide for several reasons:
✅ Why discontinue glyburide:
Redundant mechanism: Sulfonylureas stimulate insulin secretion. Once rapid-acting insulin
is given before meals, glyburide becomes unnecessary.
Increased risk of hypoglycemia: Combining glyburide with both basal and bolus insulin
significantly increases the risk of low blood sugar.
No added benefit: There's limited additional glycemic benefit when using sulfonylureas
alongside a full insulin regimen.
✅ Continue metformin:
Metformin helps reduce insulin resistance and does not cause hypoglycemia.
4
