1. A 66-year-old Hispanic man (weight 123.
8 kg; body mass index [BMI] 42 kg/m2 ) with a
history of dyslipidemia and hypertension received a diagnosis of type 2 diabetes (T2D). After
1 month of exercise and dietary changes and no diabetes medications, his hemoglobin A1C
(A1C) and fasting glucose concentration today are 11.5% and 362 mg/dL, respectively. Which
set of drugs is best to initiate?
A. Metformin and glipizide.
B. Glipizide and insulin glulisine.
C. Pioglitazone and acarbose.
D. Insulin detemir and glulisine.
2. A patient weighing 65 kg with symptoms of hyperglycemia and a fasting glucose
concentration of 298 mg/dL is given a diagnosis of type 1 diabetes (T1D). The patient’s
physician asks for a recommendation of an appropriate starting dose of basal insulin and
estimates the total daily insulin (TDI) needs of 0.4 unit/kg/day. Which recommendation is
most appropriate?
A. 13 units of insulin detemir.
B. 13 units of insulin aspart.
C. 26 units of insulin glargine.
D. 26 units of insulin glulisine.
3. A patient with T2D has a blood pressure reading of 152/84 mm Hg, a serum creatinine
(SCr) of 1.8 mg/dL, and two recent random urine albumin/ creatinine concentrations of 420
and 395 mg/g. Which class of drugs (barring any contraindications) is best to initiate in this
patient?
A. Thiazide diuretic.
B. Dihydropyridine calcium channel blocker.
C. Angiotensin receptor blocker (ARB).
D. Non-dihydropyridine calcium channel blocker.
4. A woman with T2D has an A1C of 8.6%. She is receiving insulin glargine (60 units once
daily at bedtime) and insulin aspart (8 units before breakfast, 7 units before lunch, and 12
units before dinner). She is consistent in her carbohydrate intake at each meal. Her morning
fasting plasma glucose (FPG) and premeal blood glucose (BG) readings have consistently
averaged 112 mg/dL. Her bedtime readings are averaging 185–200 mg/dL. Which is the best
insulin adjustment to improve her overall glycemic control?
A. Increase prebreakfast aspart to 10 units.
B. Increase predinner aspart to 14 units.
C. Increase bedtime glargine to 65 units.
D. Increase prelunch aspart to 9 units.
5. A 53-year-old Hispanic woman has a BMI of 44 kg/m2 and a history of gestational
diabetes. Her mother and sister both have T2D. Two weeks ago, her A1C was 7.4%. Her
fasting glucose concentration today is 178 mg/dL. She is asymptomatic. Which is the best
course of action?
A. Diagnose T2D and begin treatment.
B. Diagnose T1D and begin treatment.
C. Obtain another A1C today.
D. Obtain another glucose concentration another day.
6. A 42-year-old man has a history of T2D. His current therapy includes metformin 1000 mg
twice daily, glyburide 10 mg twice daily, and aspirin 81 mg once daily. Today, his A1C is 6.9%,
blood pressure is 126/78 mm Hg, and fasting lipid panel is as follows: total cholesterol 212
mg/dL, low density lipoprotein cholesterol (LDL) 98 mg/dL, high-density lipoprotein
cholesterol (HDL) 45 mg/dL, and triglycerides (TG) 145 mg/dL. Which would be most
appropriate for this patient?
A. Add insulin detemir 10 units once daily.
B. Add lisinopril 10 mg once daily.
C. Add atorvastatin 10 mg once daily.
D. Add fenofibrate 145 mg once daily.
7. A 64-year-old woman has had a 12-kg (27 lb) weight increase during the past year,
primarily because of inactivity and a poor diet. Her BMI is 44 kg/m2 . Her mother and sister
both have T2D. Her fasting glucose concentration today is 212 mg/dL. Which is the best
course of action?
A. Diagnose T2D and begin treatment.
B. Diagnose T1D and begin treatment.
C. Obtain another glucose concentration today.
D. Obtain an A1C today in addition to the glucose concentration.
8. A 21-year-old patient (weight 80 kg) is given a diagnosis of T1D after the discovery of
elevated glucose concentrations (average 326 mg/dL), and the patient has signs and
symptoms of hyperglycemia. Which is the most appropriate initial dose of rapid-acting
insulin before breakfast for this patient? (Assume a TDI regimen of 0.5 unit/kg/day.)
A. 2 units.
B. 4 units.
C. 7 units.
D. 14 units.