START Module 3: Insulin initiation in type 2 diabetes
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- Question 1 of 15
1. Question
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2. Question
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3. Question
- Question 4 of 15
4. Question
- Question 5 of 15
5. Question
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6. Question
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7. Question
- Question 8 of 15
8. Question
Hint
The new Clinical Guidelines Committee of the American College of Physicians recommends that patients with T2DM should be treated to achieve an A1c between 7% and 8%.
- Question 9 of 15
9. Question
Hint
While clinical considerations are always subject to patient preference, this patient is motivated to avoid target organ disease and she will benefit to a greater extent with insulin than any of the other antidiabetic agents, none of which would achieve the desired HbA1c lowering of >1.5%.
- Question 10 of 15
10. Question
Hint
The value of a basal insulin in this situation relates to less weight gain and less hypoglycaemia. In the ‘4-T’ trial, weight gain was lower than with biphasic insulin twice-daily and prandial insulin.
- Question 11 of 15
11. Question
Hint
The SEMDSA guidelines advise a starting dose of 10µ at bedtime, ensuring that patient support from the clinician or allied healthcare staff is available.
- Question 12 of 15
12. Question
- Question 13 of 15
13. Question
Hint
This profile demonstrates how the glucose levels fall overnight, suggesting that the problem is not a deficiency of basal insulin but rather a post-dinner rise in blood glucose. A step-up approach of adding a prandial short-acting insulin would work well.
- Question 14 of 15
14. Question
- Question 15 of 15
15. Question
Hint
The most likely reason is that her PPG levels are high.
Preesha then refers to her diary and points out that she has been testing her blood glucose after lunch (her main meal everyday over the past week.) Her blood glucose after lunch is 10.3-13.2mmol/L. She has been doing this because she is not losing weight anymore and is in fact 1kg heavier and is concerned about this. Insulin intensification strategies are now needed.