ABFM DIABETES || Complete Exam File: High-
Scoring Q&A Set!!
True statements regarding nonpharmacologic therapy to reduce insulin resistance include
which of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
Exercise has been shown to enhance insulin action in skeletal muscle
A decrease of as little as 5% in body weight can result in a substantial reduction in insulin
resistance
If there are no contraindications, patients with insulin resistance syndrome should be advised
to engage in 30 minutes of modest aerobic exercise at least 4-5 times/week correct answers
A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance syndrome.
Losing even 5% of body weight has been shown to substantially reduce insulin resistance. In
addition, insulin sensitivity can be increased by reducing caloric intake, even if no weight is
lost. Exercise is an important adjunct to weight loss, since it has been shown to enhance
insulin action in skeletal muscle not only during physical activity but for up to a week
following exercise. All patients with insulin resistance syndrome should be advised to engage
in 30 minutes of aerobic exercise at least 4-5 times/week. Moderate alcohol intake lowers
insulin resistance.
Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton correct answers A
Failure to perceive a pressure sensation produced by Semmes-Weinstein monofilament
indicates a loss of protective sensation in the diabetic foot and is highly predictive of foot
ulceration. Traditional neurologic examination techniques for evaluating reflexes,
proprioception, vibration, or light touch are highly subjective and less predictive of future
ulceration.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all that are
true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) correct answers D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an
increase of 15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol by 5%-
,25%. Hyperglycemia is a side effect of niacin therapy, particularly at high doses. A dosage of
750-2000 mg/day is associated with only moderate rises in blood glucose, and at one time
was considered a treatment option in patients with diabetes, particularly those with low HDL-
cholesterol levels. However, the recommendations for niacin use were changed as a result of
the AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome with Low
HDL/High Triglycerides: Impact on Global Health Outcomes), which found no incremental
clinical benefit from the addition of niacin to statin therapy in patients with coronary heart
disease and LDL-cholesterol levels >70 mg/dL.Recent studies support a link between statin
use and the development of diabetes mellitus. In a meta-analysis of 13 studies, statin therapy
was associated with a 9% increased risk for incident diabetes. Another meta-analysis
corroborated this result and found that intensive-dose statin therapy was associated with a
higher risk of new-onset diabetes compared with moderate-dose statin therapy. In 2012, the
FDA modified the package labeling of statins to include the risk of increased blood glucose
levels and the development of type 2 diabetes. The benefit of statin therapy, however,
outweighs the risk; it was estimated there would be 1 additional case of diabetes for every
498 patients treated for 1 year, compared with 1 less patient experiencing a cardiovascular
event for every 155 patients treated for 1 year.
A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon for his
annual physical examination. His current medication regimen consists of insulin glargine
(Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day; metformin (Glucophage),
1000 mg twice a day; and acarbose (Precose), 100 mg three times a day. He suddenly
becomes shaky, diaphoretic, and pale, and tells you he thinks it is because he skipped lunch
before his appointment.Which of the following would be effective for managing this episode?
(Mark all that are true.)
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon correct answers A AND F
Acarbose, an α-glucosidase inhibitor, inhibits an enzyme present in the brush border of the
proximal intestinal epithelium that breaks down disaccharides and more complex
carbohydrates. As a result, if hypoglycemia were to occur in a patient on an α-glucosidase
inhibitor, reversal requires either the consumption of glucose itself (as opposed to complex
carbohydrates) or the injection of glucagon.
Which of the following medications can cause hyperglycemia? (Mark all that are true.)
Niacin
Clozapine (Clozaril)
Prednisone
Spironolactone
Ramipril (Altace) correct answers A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in impaired
glucose tolerance and hyperglycemia. Agents associated with the development of
hyperglycemia include pentamidine, niacin, glucocorticoids, thyroid hormone, diazoxide, β-
, adrenergic agonists, thiazide diuretics, phenytoin, and α-interferon. In addition, second-
generation antipsychotic agents, particularly clozapine and olanzapine, have also been linked
to the development of hyperglycemia and diabetes mellitus. Spironolactone and ramipril have
not been linked to the development of diabetes. In fact, in the HOPE (Heart Outcomes
Prevention Evaluation) study, the use of ramipril, an ACE inhibitor, appeared to reduce the
risk for developing type 2 diabetes mellitus by 20%-35%.
A 55-year-old African-American male sees you for a routine visit. His past medical history is
notable for an 8-year history of diabetes mellitus and a past history of hypercholesterolemia.
His current medications are atorvastatin (Lipitor), 20 mg/day, and extended-release
metformin (Glucophage XR), 1000 mg/day. He also reports a history of peanut allergy
manifested by lip angioedema, and carries an epinephrine auto-injector (EpiPen).On
examination he has a blood pressure of 124/80 mm Hg. His hemoglobin A1c is 6.7%. A spot
urine sample contains 40 µg albumin/mg creatinine.You see the patient 6 months later for a
follow-up visit, and a spot urine sample has an albumin/creatinine ratio of 45 µg/mg.Which
one of the following would be most appropriate initially?
Have the patient return in 6 months for a repeat urine test for albumin and creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient correct answers E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the leading
cause of end-stage renal disease. Persistent albuminuria in the range of 30-200 mg/24 hr
(microalbuminuria) is the earliest sign of nephropathy in patients with type 1 diabetes, and is
a marker for nephropathy in type 2 diabetes. Patients with microalbuminuria who progress to
macroalbuminuria (>300 mg/24 hr) are likely to progress to end-stage renal disease over a
period of years.Although timed 4- and 24-hour urine collections for creatinine can be used to
screen for microalbuminuria, a random spot urine specimen for measurement of the albumin-
to-creatinine ratio is the preferred method. A minimum of two of three tests showing a urine
albumin level >30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and
angiotensin receptor blockers (ARBs) have been shown to delay the progression from
microalbuminuria to macroalbuminuria in patients with type 1 or type 2 diabetes. Since the
antiproteinuric effect is believed to be independent of blood pressure, current ADA
guidelines recommend the use of ACE inhibitors or ARBs as first-line therapy for both type 1
and type 2 diabetic patients with microalbuminuria, even if their blood pressure is normal.
Some studies, however, have raised questions about the value of early renin-angiotensin
blockade for preventing microalbuminuria in normotensive patients with type 1 or type 2
diabetes, and ADA guidelines recommend against the use of these drugs for patients with
normal blood pressure and no albuminuria.Compared to whites, African-Americans and
Asians have a three- to fourfold higher risk of angioedema associated with the use of ACE
inhibitors. The American Heart Association recommends that ACE in
True statements regarding carbohydrate intake and diabetes mellitus include which of the
following? (Mark all that are true.)
The glycemic index is not useful in the management of diabetes mellitus
Carbohydrate sources high in protein are effective for treating hypoglycemia
Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets (<130
g/day)
Scoring Q&A Set!!
True statements regarding nonpharmacologic therapy to reduce insulin resistance include
which of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
Exercise has been shown to enhance insulin action in skeletal muscle
A decrease of as little as 5% in body weight can result in a substantial reduction in insulin
resistance
If there are no contraindications, patients with insulin resistance syndrome should be advised
to engage in 30 minutes of modest aerobic exercise at least 4-5 times/week correct answers
A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance syndrome.
Losing even 5% of body weight has been shown to substantially reduce insulin resistance. In
addition, insulin sensitivity can be increased by reducing caloric intake, even if no weight is
lost. Exercise is an important adjunct to weight loss, since it has been shown to enhance
insulin action in skeletal muscle not only during physical activity but for up to a week
following exercise. All patients with insulin resistance syndrome should be advised to engage
in 30 minutes of aerobic exercise at least 4-5 times/week. Moderate alcohol intake lowers
insulin resistance.
Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton correct answers A
Failure to perceive a pressure sensation produced by Semmes-Weinstein monofilament
indicates a loss of protective sensation in the diabetic foot and is highly predictive of foot
ulceration. Traditional neurologic examination techniques for evaluating reflexes,
proprioception, vibration, or light touch are highly subjective and less predictive of future
ulceration.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all that are
true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) correct answers D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an
increase of 15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol by 5%-
,25%. Hyperglycemia is a side effect of niacin therapy, particularly at high doses. A dosage of
750-2000 mg/day is associated with only moderate rises in blood glucose, and at one time
was considered a treatment option in patients with diabetes, particularly those with low HDL-
cholesterol levels. However, the recommendations for niacin use were changed as a result of
the AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome with Low
HDL/High Triglycerides: Impact on Global Health Outcomes), which found no incremental
clinical benefit from the addition of niacin to statin therapy in patients with coronary heart
disease and LDL-cholesterol levels >70 mg/dL.Recent studies support a link between statin
use and the development of diabetes mellitus. In a meta-analysis of 13 studies, statin therapy
was associated with a 9% increased risk for incident diabetes. Another meta-analysis
corroborated this result and found that intensive-dose statin therapy was associated with a
higher risk of new-onset diabetes compared with moderate-dose statin therapy. In 2012, the
FDA modified the package labeling of statins to include the risk of increased blood glucose
levels and the development of type 2 diabetes. The benefit of statin therapy, however,
outweighs the risk; it was estimated there would be 1 additional case of diabetes for every
498 patients treated for 1 year, compared with 1 less patient experiencing a cardiovascular
event for every 155 patients treated for 1 year.
A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon for his
annual physical examination. His current medication regimen consists of insulin glargine
(Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day; metformin (Glucophage),
1000 mg twice a day; and acarbose (Precose), 100 mg three times a day. He suddenly
becomes shaky, diaphoretic, and pale, and tells you he thinks it is because he skipped lunch
before his appointment.Which of the following would be effective for managing this episode?
(Mark all that are true.)
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon correct answers A AND F
Acarbose, an α-glucosidase inhibitor, inhibits an enzyme present in the brush border of the
proximal intestinal epithelium that breaks down disaccharides and more complex
carbohydrates. As a result, if hypoglycemia were to occur in a patient on an α-glucosidase
inhibitor, reversal requires either the consumption of glucose itself (as opposed to complex
carbohydrates) or the injection of glucagon.
Which of the following medications can cause hyperglycemia? (Mark all that are true.)
Niacin
Clozapine (Clozaril)
Prednisone
Spironolactone
Ramipril (Altace) correct answers A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in impaired
glucose tolerance and hyperglycemia. Agents associated with the development of
hyperglycemia include pentamidine, niacin, glucocorticoids, thyroid hormone, diazoxide, β-
, adrenergic agonists, thiazide diuretics, phenytoin, and α-interferon. In addition, second-
generation antipsychotic agents, particularly clozapine and olanzapine, have also been linked
to the development of hyperglycemia and diabetes mellitus. Spironolactone and ramipril have
not been linked to the development of diabetes. In fact, in the HOPE (Heart Outcomes
Prevention Evaluation) study, the use of ramipril, an ACE inhibitor, appeared to reduce the
risk for developing type 2 diabetes mellitus by 20%-35%.
A 55-year-old African-American male sees you for a routine visit. His past medical history is
notable for an 8-year history of diabetes mellitus and a past history of hypercholesterolemia.
His current medications are atorvastatin (Lipitor), 20 mg/day, and extended-release
metformin (Glucophage XR), 1000 mg/day. He also reports a history of peanut allergy
manifested by lip angioedema, and carries an epinephrine auto-injector (EpiPen).On
examination he has a blood pressure of 124/80 mm Hg. His hemoglobin A1c is 6.7%. A spot
urine sample contains 40 µg albumin/mg creatinine.You see the patient 6 months later for a
follow-up visit, and a spot urine sample has an albumin/creatinine ratio of 45 µg/mg.Which
one of the following would be most appropriate initially?
Have the patient return in 6 months for a repeat urine test for albumin and creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient correct answers E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the leading
cause of end-stage renal disease. Persistent albuminuria in the range of 30-200 mg/24 hr
(microalbuminuria) is the earliest sign of nephropathy in patients with type 1 diabetes, and is
a marker for nephropathy in type 2 diabetes. Patients with microalbuminuria who progress to
macroalbuminuria (>300 mg/24 hr) are likely to progress to end-stage renal disease over a
period of years.Although timed 4- and 24-hour urine collections for creatinine can be used to
screen for microalbuminuria, a random spot urine specimen for measurement of the albumin-
to-creatinine ratio is the preferred method. A minimum of two of three tests showing a urine
albumin level >30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and
angiotensin receptor blockers (ARBs) have been shown to delay the progression from
microalbuminuria to macroalbuminuria in patients with type 1 or type 2 diabetes. Since the
antiproteinuric effect is believed to be independent of blood pressure, current ADA
guidelines recommend the use of ACE inhibitors or ARBs as first-line therapy for both type 1
and type 2 diabetic patients with microalbuminuria, even if their blood pressure is normal.
Some studies, however, have raised questions about the value of early renin-angiotensin
blockade for preventing microalbuminuria in normotensive patients with type 1 or type 2
diabetes, and ADA guidelines recommend against the use of these drugs for patients with
normal blood pressure and no albuminuria.Compared to whites, African-Americans and
Asians have a three- to fourfold higher risk of angioedema associated with the use of ACE
inhibitors. The American Heart Association recommends that ACE in
True statements regarding carbohydrate intake and diabetes mellitus include which of the
following? (Mark all that are true.)
The glycemic index is not useful in the management of diabetes mellitus
Carbohydrate sources high in protein are effective for treating hypoglycemia
Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets (<130
g/day)
