Practice Test | Level 3 | Meds for Type 2 | 2026

Meds for Type 2 | 2026

Carlos is worried about starting dapagliflozin (Farxiga) because of the side effects. Which of the following reflects the main action of SGLT-2 Inhibitors?

opposes the action of insulin

enhances gastric emptying

promotes glucagon release

decreases glucose re-absorption

decreases glucose re-absorption

AJ has been instructed to take nateglinide (Starlix 60mg) before each meal. AJ frequently eats only breakfast and dinner. What would be the best recommendation for AJ?

Only take if AJ plans to eat a meal.

Only take at lunch time if blood glucose levels are greater than 110mg/dl.

Take three times a day, whether or not AJ eats lunch.

Double the dinner dose if blood glucose levels are greater than 150mg/dl.

Only take if AJ plans to eat a meal. (Nateglinide (Starlix) is a meglitinide medication designed to stimulate insulin secretion specifically in response to a meal.

• Because it lowers blood sugar rapidly, taking it without eating a meal increases the risk of low blood sugar (hypoglycemia).

• Since AJ skips lunch, the dose scheduled for lunchtime should be skipped rather than taken or doubled.)

People with type 2 diabetes taking sulfonylureas or meglitinides should be counseled about which of the following?

take medication, even if they are not able to eat

make sure to eat after taking medication

medications may cause nausea and weight loss

take extra medications if glucose levels are elevated

make sure to eat after taking medication to avoid hypoglycemia.

BT has been on glipizide (Glucotrol) 1O mg BID for the past four years, but BTs A1c has progressively increased and is now 7.8%. Pioglitazone (Actos) 45 mg daily was added to BTs regimen a month ago. During your initial assessment, BT complains that she has had a recent weight gain of 6 lbs. and cannot figure out why. The most likely cause of BTs weight gain is:

recent stressful life events

fluid retention

decreasing frequency of exercise

acute renal failure

fluid retention (Weight gain from pioglitazone comes from two main things: retaining fluid (water weight) and building harmless fat right under the skin.

Here is how it works simply:

• Water weight: The medicine makes the kidneys hold onto extra sodium and water, which often causes mild swelling in the legs.

• Shifting fat: It moves harmful fat away from internal organs and stores it safely under the skin instead.

Even though you might gain 4 to 6 pounds, your body actually becomes more sensitive to insulin because the dangerous organ fat is decreasing.)

Indicate which of the following conditions is a contraindication for metformin (Glucophage) therapy:

thyroid disorders

hypertriglyceridemia

gout requiring medications

excess alcohol intake

excess alcohol intake (Both acute binge drinking and chronic excessive alcohol consumption significantly potentiate metformin's effect on lactate metabolism. Because alcohol inhibits glucose production and decreases lactate clearance by the liver, combining it with metformin dramatically elevates the risk of lactic acidosis—a rare but life-threatening medical emergency.)

LS is being started on a glucosidase inhibitor. Which of the following would you include in your instructions?

take only if blood glucose is above target range

in case of low blood sugar, consume glucose tabs

take medication 30 to 45 minutes after a meal

treat hypoglycemia with 6-8 lifesavers

in case of low blood sugar, consume glucose tabsto treat hypoglycemia.

RT is taking exenatide XR (Bydureon) once-a-week injection. Of the following issues, which one should RT report to his provider immediately?

Slight bump on the injection site.

Nausea after injections.

Sudden abdominal pain.

Blood glucose level of 187 mg/dl.

Sudden abdominal pain. (Sudden abdominal pain can indicate a serious condition such as pancreatitis, which requires immediate medical attention.)

JR is taking empagliflozin (Jardiance) once daily. During your teaching session, you share the pros and cons of this class of medications. Which of the following is a side effect of SGLT-2 Inhibitors?

Fournier's Gangrene

Weight gain

Extreme satiation

Kidney failure

Fournier's Gangreneis (a rare but serious infection of the genitals and perineum that can occur in patients taking SGLT-2 inhibitors. It requires urgent medical attention and intervention.)

An individual with type 2 tells you she is drinking aloe juice to control her diabetes. The best response is:

"aloe juice has not been scientifically proven to lower blood glucose levels"

"aloe juice has been proven to decrease glucose levels"

"tell me about your overall blood sugar levels"

"folk remedies usually don't work"

"tell me about your overall blood sugar levels"

Metformin (Glucophage):

• Decreases glucose release from liver

• "glucoretic"

• Incretin Mimetics

• Stimulates insulin release from pancreas

Decreases glucose release from liver

SGLT-2 Inhibitor:

• "glucoretic"

• Incretin Mimetics

• Stimulates insulin release from pancreas

glucoretic (promotes glucose excretion through urine)

GLP-1 RA:

1.Decreases glucose release from liver

2."glucoretic"

3.Incretin Mimetics

4.Stimulates insulin release from pancreas

Incretin Mimetics (that enhance insulin secretion and lower blood glucose levels.)

Sulfonylureas:

1.Decreases glucose release from liver

2."glucoretic"

3.Incretin Mimetics

4.Stimulates insulin release from pancreas

Stimulates insulin release from pancreas

LP has type 2 diabetes and a BMI of 28. LP was just released from the hospital after being treated for a myocardial infarction. LP's GFR is below 60 and LP takes metformin 1000mg BID. A1c is 8.8%. Blood Pressure is 138/82. According to the ADA Standards of Care, which diabetes medication class would most benefit LP based on their co-conditions?

SGLT-2 Inhibitor

Basal Insulin

DPP-IV Inhibitor

Glucosidase Inhibitor

SGLT-2 Inhibitor

MS has type 2 diabetes, a BMI of 32 and an A1c  of 6.3%. Takes canagliflozin (Invokana) and follows their meal plan. In discussing preconception care, the educator will suggest which of the following?

delay conception until she achieves a 20% weight loss

discontinue canagliflozin (Invokana) and start MS on insulin

start MS on prenatal vitamins

discontinue canagliflozin (Invokana) and start glyburide

discontinue canagliflozin (Invokana) and start MS on insulin

(Contraindication of SGLT2 Inhibitors: Non-insulin therapies, including SGLT2 inhibitors like canagliflozin (Invokana), are not recommended during pregnancy due to potential risks to fetal renal development and a lack of long-term safety data. They should be discontinued prior to conception.

• Insulin is First-Line: Insulin is the preferred pharmacologic treatment for managing preexisting type 2 diabetes during preconception and pregnancy because it does not cross the placenta and allows for precise glycemic titration. [1, 2]

• Avoidance of Certain Oral Agents: Glyburide is no longer recommended as a first-line alternative because it crosses the placenta and is associated with increased risks of neonatal hypoglycemia and macrosomia. [1, 2]

• Glycemic Targets Achieved: MS already has an A1c of 6.3%, which meets the standard preconception target of <6.5%. Therefore, delaying conception for an aggressive 20% weight loss is unnecessary, though standard prenatal vitamins should still be started as a routine measure rather than a specialized diabetes intervention)

DPP-IV Inhibitors lower blood glucose by:

increasing metabolic rate.

inhibiting gluconeogenesis.

increasing gut hormone levels

potentiating glucagon production.

increasing gut hormone levels (These medications work by blocking the enzyme dipeptidyl peptidase-4 (DPP-IV). This enzyme normally breaks down incretin hormones like GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). By inhibiting this enzyme, the drugs keep gut hormone levels elevated longer, which:

• Stimulates insulin secretion from the pancreas (glucose-dependent).

• Lowers glucagon secretion, reducing glucose release from the liver.)

People on long term metformin therapy are at risk for:

B12 deficiency.

bone fractures

hepatic inflammation

transient kidney failure

B12 deficiency.

GLP-1 RAs are like "gut hormone replacement therapy".   Of the following, who is a candidate for GLP-1 RA therapy? A person with diabetes and

a history of gastroparesis

a history of hypertension

a BMI of 23 or less

family history of thyroid disease

a history of hypertension (aperson with a history of hypertension is an excellent candidate for GLP-1 receptor agonist (GLP-1 RA) therapy. [1]

GLP-1 RAs provide significant cardiovascular benefits, including reducing blood pressure and lowering the risk of major adverse cardiovascular events (MACE))

Based on the latest ADA Standard 9, Pharmacologic

Approaches to Glycemic Management, which of the

following is an accurate recommendation?

A. Initiate treatment with metformin for most individuals,

including those with cardiovascular disease.

B. If A1C not at target with 2 or more oral agents, add on

basal insulin therapy.

C. Avoid the use of SGLT-2 Inhibitors in those with an eGFR

of less than 25.

D. Prioritize the use of organ protective medications in

those with cardiorenal disease.

D. Prioritize the use of organ protective medications in

those with cardiorenal disease.

According to the ADA Glycemic Treatment

Algorithm, what is the first step to manage

hyperglycemia in type 2? a. Lifestyle modification and metformin

b. Start with weight loss and exercise for 3

months c. Start either metformin, SGLT-2i or GLP-1 RA

and lifestyle

d. Start 2 meds if their A1c is 7.5%

c. Start either metformin, SGLT-2i or GLP-1 RA

and lifestyle

JR is started on Metformin 500mg BID.

Which of the following is true? a. Hold metformin if blood glucose

below 90 mg/dl.

b. Evaluate B12 levels before starting

medication.

c. Metformin is considered weight

neutral

d. Metformin can cause kidney damage,

so increase fluid intake

c. Metformin is considered weight neutral

MT has newly diagnosed type 2 and is

concerned about taking glipizide. Which of

the following teaching points is most

important for people on sulfonylureas?

a. Most people experience some weight loss.

b. 50% of people with diabetes have no

improvement in BG levels.

c. Do not take with grapefruit juice.

d. If feel shaky, eat something with sugar.

d. If feel shaky, eat something with sugar.

FZ is older and lives alone. Very concerned

about avoiding hypoglycemia, since brother

almost died from a hypoglycemic incident.

Which medication class would you

recommend? a. Meglitinides

b. SGLT-2 Inhibitors c. Sulfonylureas

d. Analog insulins

b. SGLT-2 Inhibitors

MT has a strong family history of ASCVD, along

with type 2 diabetes and a BMI of 31. A1C

8.3%. They take metformin 1000mg BID. Based

on this information, which of the following

meds would you consider adding?

 A. dulaglutide

 B. glipizide

 C. rosiglitazone

 D. linagliptin

A. dulaglutide

WR has diabetes is on max dose Metformin and

Sulfonylurea. A1C is 8.4. Has been trying to lose

weight with limited success. Which of the

following medications would be indicated? a. Basal insulin

b. GLP-1 Receptor Agonists c. Meglitinides

d. Bolus insulin

b. GLP-1 Receptor Agonists

AR is 36 years old with type 2 diabetes and a BMI of

41. Current diabetes medications include: metformin,

sitagliptin and empagliflozin at maximum doses. AR is

prescribed tirzepatide. Based on this information, what

action do you recommend to the provider? A. Verify kidney function first. B. Stop the sitagliptin when initiating tirzepatide. C. Decrease the dose of metformin to prevent

hypoglycemia. D. Evaluate thyroid function before starting tirzepatide.

B. Stop the sitagliptin when initiating tirzepatide.

On Metformin 1000mg BID and sitagliptin

(Januvia), A1c 8.1%. GFR 47, UACR 158mg/g

 Recent Myocardial Infarction with Congestive

Heart Failure (HFrEF). These are the medications

his insurance covers. What is the best choice?

 A. glipizide

 B. pioglitazone

 C. semaglutide

 D. empagliflozin

D. empagliflozin

JR, a 67-year-old with type 2 diabetes for 7 years, with an

A1C of 9.7% was started on empagliflozin 10mg two weeks

ago. Other labs include a GFR of 49 and a UACR of 34

mg/g. Other diabetes medications include Glucotrol 10mg

twice daily and pioglitazone. JR sometimes has a few shot’s

of whiskey before bed, especially if they had a stressful day.

JR’s partner calls you in a panic and says JR is admitted to

the hospital in DKA. What is the most likely explanation?