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MAKING BEST PRACTICE, EVERYDAY PRACTICE

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In-time, insulin intervention – The right insulin, the right patient – Case study 5

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In-time, insulin intervention – The right insulin, the right patient – Case study 5
In-time, insulin intervention – The right insulin, the right patient – Case study 5

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Question 1 of 10

1. Question

1. Which of the following best explains Ms EM’s deteriorating glycaemic control despite an already intensified basal-bolus regimen?

A. Progressive beta-cell failure requiring still higher insulin doses
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B. Treatment burden leading to inconsistent bolus dosing
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C. Insufficient basal insulin dose
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D. New-onset type 1 diabetes
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Question 2 of 10

2. Question

2. What examination finding is most likely contributing to Ms EM’s erratic glucose readings?

A. Reduced foot vibration sense
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B. Lipohypertrophy at injection sites with inconsistent rotation
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C. Elevated blood pressure
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D. Weight gain alone
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Question 3 of 10

3. Question

3. Ms EM’s total daily insulin dose is 46 units (28 U basal + 18 U bolus) for a weight of 90 kg — approximately 0.51 U/kg/day. Which concept is most relevant to her ongoing care?

A. She requires a further increase in basal insulin dose
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B. She may be approaching ‘overbasalisation’ and needs regimen reassessment rather than further insulin escalation
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C. She needs a twice-daily premixed insulin added to her current regimen
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D. She should restart a sulphonylurea
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Question 4 of 10

4. Question

4. The recurrent pre-lunch hypoglycaemia alternating with post-lunch hyperglycaemia seen in Ms EM’s diary indicates a need to increase her lunchtime insulin aspart dose.

A. True
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B. False
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Question 5 of 10

5. Question

5. Which treatment change would most appropriately address both Ms EM’s glycaemic pattern and her wish to simplify therapy?

A. Switch to a twice-daily premixed insulin
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B. Add a DPP-4i to the basal-bolus regimen
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C. Switch from basal-bolus insulin to a FRC of basal insulin and GLP-1 RA (iGlarLixi)
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D. Increase the basal insulin dose further
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Question 6 of 10

6. Question

6. What specific problems should be anticipated when initiating iGlarLixi in Ms EM, and what safety-nets should be put in place?

A. Gastrointestinal side effects (nausea) requiring slow, product-insert-guided dose titration and dietary counselling
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B. Hypoglycaemia risk if prandial insulin is not appropriately discontinued at initiation
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C. The need to base the starting dose on her current basal insulin dose, not her total daily insulin dose
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D. All of the above
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Question 7 of 10

7. Question

7. What encouragement or reassurance is most appropriate to offer Ms EM at this visit

A. That her early experience (fewer injections, resolving nausea, no hypoglycaemia so far) is consistent with published trial evidence for iGlarLixi versus basal-bolus therapy
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B. That she should expect no further change in her glucose control from this point
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C. That nausea is likely to worsen indefinitely and she should consider stopping the medication
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D. That she will need to restart her prandial insulin soon
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Question 8 of 10

8. Question

8. Do you make any further changes to medication at this stage, based on her self-monitoring history?

A. Yes
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B. No
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Question 9 of 10

9. Question

9. What investigations or checks are most appropriate at this juncture?

A. Repeat HbA1c today, as it is now overdue
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B. Weight/BMI, review of injection sites for resolving lipohypertrophy and gastrointestinal tolerability, with HbA1c deferred to three months
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C. An oral glucose tolerance test
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D. Immediate referral for continuous glucose monitoring
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Question 10 of 10

10. Question

10. iGlarLixi achieved comparable, or better, glycaemic control than Ms EM’s prior basal-bolus regimen, with fewer injections and a lower risk of hypoglycaemia — consistent with the published trial evidence discussed earlier in this case.

A. True
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B. False
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