Glucommander Provider Education Sessions-Enduring Material

The University of South Carolina School of Medicine-Palmetto Health CME Organization strives to deliver quality programs that meet your educational needs. Please take a moment to share your experiences with us through this brief questionnaire. Your feedback will be taken into consideration as we plan for future activities.

Question Title

* 1. Please fill out the below information:

Name *

Credentials (MD, DO, RN, NP, etc) *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Are you a resident?

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* 3. Please list your Department (i.e. Surgery, Family Medicine, Pediatrics, etc.)

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* 4. Please list the name of your practice below:

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* 5. Please check all the campuses where you have privileges.

Baptist

Baptist Easley

Parkridge

Richland

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* 6. Mr. Wilson is a 61 year old white male with a history of CHF, chronic atrial fibrillation, CAD, HTN, GERD, gout, hyperlipidemia, and type 2 diabetes mellitus who is admitted with congestive heart failure. He is on 2000mg metformin XR, 8mg glimepiride, and glargine 45 units daily as an outpatient. His admission weight is 120 kg and his most recent A1c was 7.2%. Labs on admission include (but are not limited to):

BASIC METABOLIC PANEL Reference
SODIUM 141 mmol/L [135-145]
POTASSIUM 3.8 mmol/L [3.5-5.0]
CHLORIDE 106 mmol/L [98-108]
CARBON DIOXIDE 27 mmol/L [21-30]
UREA NITROGEN 11 mg/dL [7-20]
CREATININE 0.9 mg/dL [0.4-1.0]
CALCIUM 9.8 mg/dL &

His A1c and creatinine are good. There is no reason not to continue all outpatient medications and add correction scale insulin

Stop his outpatient regimen and begin 0.5 units/kg/day basal-bolus-correction insulin therapy.

Continue outpatient Lantus, hold oral medications and start correction scale insulin with meals.

Stop all his outpatient therapy and start sliding scale insulin.

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* 7. Which of the following is most important in preventing hypoglycemia:

Establishing individualized goals for each patient.

Holding insulin for NPO patients.

Targeting all blood glucoses < 180mg/dl

Assessing A1c on admission.

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* 8. Mr. Simpson is a 73-year old man with type 2 diabetes who has suffered a fractured trochanter after falling from a ladder. At home, he takes multiple oral anti-diabetes medications. Upon admission to the hospital, his glucose was 336 mg/dL and his A1c was 8.8%. Mr. Johnson's oral medication were discontinued and he was started on weight based insulin. When should he begin insulin therapy?

On admission.

In post-op.

Once on the nursing unit after ORIF.

The morning after his surgery based on his blood glucose level.

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* 9. Mr. Cooper is an 82 year old male with history of type 2 diabetes and CKD-4 who weights 80 kg. You are starting him on Glucommander with a weight based start of .3 units/kg and target range of 140-180. You can expect Glucommander to provide which initial dose recommendations:

Basal of 24, bolus of 8 for each meal.

Basal of 28, bolus of 10 for each meal.

Basal of 8, bolus of 2 for each meal.

Basal of 12, bolus of 4 for each meal.

Mrs. Brown is a 86 year old female with a history of type 2 diabetes, mild CKD, and GERD. She is admitted for community acquired pneumonia. Her outpatient diabetes regimen is glimepiride 2 mg qam wikth her most recent A1c = 6.7% and eGFR = 58.

The following two questions are related to Mrs. Brown:

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* 10. What is a best plan glycemic management for Mrs. Brown on admission?

Her A1c and creatinine are good. There is no reason not to continue her glimepiride and add correction scale insulin.

Stop her outpatient regimen and begin 0.5 units/kg/day basal-bolus-correction insulin therapy.

Stop her outpatient regimen, begin blood glucose monitoring and start weight-based insulin if her BG is persistently elevated.

Stop her glimepiride and start sliding scale insulin.

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* 11. Mrs. Brown's BGs have been 158, 196, 210, 168, 201, 189, 205. Her eGFR has declined to 43 mg/min. What would be the best blood glucose target range to order for this patient?

100-140 mg/dL

120-160 mg/dL

140-180 mg/dL

< 200 mg/dL

Congratulations, you have completed the Glucommander training. If you would you a copy of your transcript, please visit https://www.palmettohealth.org/classes-events/education/continuing-medical-education/transcripts or call our office at (803) 434-4211.