Quiz Questions

The objective of this page is to provide you sample cases to practice insulin adjustment. This page is in development and will grow. For access to formal online learning modules for healthcare providers with automatically marked quizzes, please click here.  

MEDICATIONS

Medications: Basal Insulin Adjustment in Type 2

QUESTION 1: Arthur (meds + newer basal start)

ARTHUR: What do you suggest for an insulin dose tonight? 

  • 38 years old, DM x 5 years, 68 kg, lean and active (may be LADA)
  • Started detemir (Levemir®) 3 days ago. Currently 7 units at night.
  • Metformin 1000 mg b.i.d.
  • Secretagogue: Gliclazide (Diamicron®) 160 mg b.i.d. 
  • DPP-4i: Sitagliptin (Januvia®) 100 mg daily 
  • A1c 7.6%
  • Glucose readings: prior insulin his FBS were 10-11 mmol/
  Breakfast Lunch Supper Bed
Tues 9.9   7.1 8.1
Wed 10.7     6.8
Thur 10.3     7.9
Frid 11.2       

Medications: BBIT Adjustments for Patterns

  • ICR = Insulin to Carbohydrate Ratio
  • ISF = Insulin Sensitivity Factor or Correction Factor
  • TDD =Total daily dose of insulin
    (may or may not include corrections; generally should if readings frequently over target).
QUESTION 1: Phee

Phee (they/their) is on basal, bolus insulin therapy (BBIT) with an evening basal dose and rapid insulin at meals.  Target A1c is 7%. They report being able to sense lows. No history severe hypo. 

high supper 2

1.What is their pattern? (no poll in workshop)

  • A. Lows, more than 2-3 per week or severe/unaware
  • B. High pattern in 1 or 2 places
  • C. High everywhere
  • D. Erratic at each time of the day (half target & half high)

2.What insulin would you adjust first? (poll in workshop)

  • A. Breakfast meal bolus
  • B. Lunch meal bolus
  • C. Supper meal bolus
  • D. HS basal

Resource: Insulin Adjustments, section and TABLE (here) on Adjusting for Hyperglycemia

Medications: BBIT Adjustments for No Pattern (Erratic)

  • ICR = Insulin to Carbohydrate Ratio
  • ISF = Insulin Sensitivity Factor or Correction Factor
  • TDD =Total daily dose of insulin
    (may or may not include corrections; generally should if readings frequently over target)
QUESTION: Sullivan
 

Sullivan has type 1 diabetes and is targeting A1c < 7.0%. When over target, he gives correction insulin unless he's made a comment otherwise. You clarified that all of the readings below are before meals e.g. at least 3 hours since food.  

Sullivan Glucose
  • ICR 1:18
  • ISF 3
  • Degludec 18 u at HS
  • TDD= 35 u

What do you suggest to address the problem? Pick one.

  • A. Increase basal insulin (degludec)
  • B. Change ICR to give more bolus 
  • C. Change ICR to give less bolus
  • D. Change ISF

 Resources: