RH_T2DM management in LTC & feeding_03Oct19 – HMC Continuing Pharmacy Professional Development

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Management of diabetes in long-term care settings and in people receiving enteral feeding

Presenter: Dr Justin Kurian, PharmD

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Question 1 of 8

1. Question
Some of the advantage(s) of continuous enteral feeding is/are:
- A. Greater patient mobility
- B. Better control of blood glucose levels due to continuous carbohydrate input
- C. Physiologically similar to a typical eating pattern
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Question 2 of 8

2. Question
Enteral nutrition support is indicated in following scenarios:
- A. Nutritionally depleted individuals
- B. Absence of oral intake or likelihood of absence for >5–7 days
- C. Dysphagia
- D. All of the above
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Question 3 of 8

3. Question
De-prescribing of anti-diabetic medications in an older adult is recommended if:
- A. Having long remaining life expectancy
- B. At risk of hypoglycemia (e.g. hypoglycemia history, impaired renal function, multiple comorbidities, on sulfonylurea or insulin)
- C. Experiencing adverse effects from anti-diabetic
- D. B and C
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Question 4 of 8

4. Question
Which of the following statements is true regarding diabetes management in long term care populations?
- A. Glyburide, has the highest risk of hypoglycemia and should be avoided
- B. Monitor for genital infections, urinary frequency and dehydration with SGLT2 inhibitors
- C. Extended release formulation of Metformin has fewer gastrointestinal side effects compared to an immediate release formulation
- D. Increased risk of weight gain with GLP-1 agonist
- E. A, B and C
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Question 5 of 8

5. Question
CJ, is a 69 year old female. She suffers from type II diabetes and hypertension. She has an intact cognitive and functional status. Which of the following are the best therapeutic goals for CJ?
- A. HbA1C < 8.5%; fasting glucose 100-180 mg/dL and blood pressure <150/90 mmHg
- B. HbA1C < 8%; fasting glucose 90-150 mg/dL and blood pressure <145/80 mmHg
- C. HbA1C < 7.5%; fasting glucose 90-130 mg/dL and blood pressure <140/90 mmHg
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Question 6 of 8

6. Question
Which of the following best describes the relationship between diabetes and sarcopenia
- A. Diabetes accelerates reduction of muscle mass and strength
- B. Autonomic neuropathy is another cause of sacropenia in diabetes
- C. Loss of muscle mass and increase in visceral fat result in decrease in insulin resistance
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Question 7 of 8

7. Question
Risk factors for malnutrition in older adults include:
- A. Strong social support system
- B. Dysphagia
- C. Dementia
- D. B and C
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Question 8 of 8

8. Question
CJ is a 67 year-old male, 96 kg, BMI 29.63 kg/m2 with a history of poorly controlled type 2 diabetes on oral agents as an outpatient who is admitted with a cerebral vascular event resulting in dysphagia. Initially he is on continuous tube feeding. A starting regimen of insulin while on continuous enteral nutrition would be:
- A. 12 Units of SubQ insulin glargine once daily
- B. 12 Units of SubQ regular insulin every 6 hours
- C. 12 Units of SubQ NPH 70/30 twice daily
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