Webinar: Intensifying insulin therapy for people with type 2 diabetes

This activity has been endorsed by the Pharmaceutical Society of New Zealand as suitable for inclusion in a pharmacist’s continuing education records for continuing professional development purposes. You can record details of this webinar on the “Keeping up to date” page of your portfolio on MyRecert (myrecert.pharmacycouncil.org.nz).

This 10-question multiple-choice assessment is designed to demonstrate that the webinar has been effective in allowing you to meet the learning objectives of this course. Write down your answers to these questions.

1. What is an appropriate starting dose for most people when initiating basal insulin?
a. 10 units per day
b. 20 units per day
c. 40 units per day
d. 60 units per day
e. 1 unit per kg

2. When is an appropriate time to administer insulin in people initiating this therapy?
a. At lunchtime if glucose levels tend to rise throughout the day
b. At night time if glucose levels are the highest then
c. Every second day in the morning
d. The time of day the patient will find the easiest to take the insulin regularly

3. A critical feature of premix insulins is that:
a. dose reduction is not needed when meal size is significantly reduced from normal
b. peak insulin levels are achieved 15 minutes after each dose; effect time is four hours
c. there is no need to mix the insulin pen contents before administration
d. they must be given at a meal time

4. Once you are taking bolus insulin, you have to take it at every meal. True or false?
a. True
b. False

5. Patients with diabetes can expect that once on insulin, they will have:
a. a somewhat decreased quality of life, with lower energy levels
b. far fewer hypoglycaemic episodes
c. freedom to eat more freely and flexibly
d. to accept a lifelong commitment to insulin therapy
e. weight loss

6. How do you determine the time of day for adding prandial insulin to achieve the most benefit?
a. Assess each day’s meals, and choose the best time each day based on the meal’s protein content
b. Choose the meal time when blood glucose levels are the highest afterwards
c. Dinner time is always best as that is the time of most insulin resistance
d. Select the meal time in which the meal is likely to be digested the fastest

7. For what TWO reasons may it be more appropriate to set an HbA1c target of >53mmol/L?
a. When the patient has a shorter life expectancy
b. When the patient has had previous significant unawareness of hypoglycaemic episodes
c. When the patient is able to self-fund the newer diabetes medicines
d. When the patient is an adolescent
e. When the patient is newly diagnosed with diabetes

8. What are potential clinical outcomes if HbA1c levels increase over time?
a. Amputations from peripheral vascular disorder
b. Microalbuminuria
c. Myocardial infarction
d. Nephropathy
e. Neuropathy
f. Retinopathy
g. All of the above

9. One of the main aims of the NZSSD Type 2 Diabetes Management Guidance is to:
a. delay insulin therapy for as long as possible
b. move practitioners away from standard older therapies to the newer medicines
c. reduce clinical inertia and recognise when a patient’s diabetes management needs to be reviewed
d. shift from a risk-based to a glycaemic-based diabetes management approach

10. In patients with diabetes and predominately heart failure or diabetic renal disease, which initial second-line agent would generally be preferrable?
a. Dipeptidyl peptidase-4 inhibitor
b. Glucagon-like peptide-1 receptor agonist
c. Sodium-glucose cotransporter-2 inhibitor
d. Thiazolidinedione

Write down your answers to these questions. Then, to check your answers and record your score, click here.