What is the most reliable measure for assessing diabetes control over the preceding 3-month period?

A. Epinephrine is a vasoconstrictor, meaning it narrows blood vessels at the injection site. This leads to decreased blood flow rather than increased perfusion. Although this helps reduce bleeding, the statement is incorrect because it describes the opposite effect.

B. Epinephrine causes localized vasoconstriction, which slows the absorption of lidocaine into the bloodstream. This allows the anesthetic to remain at the site longer, thereby prolonging its effect. At the same time, reduced systemic absorption lowers the risk of toxicity, such as central nervous system or cardiovascular complications.

C. Epinephrine decreases, not increases, the rate of absorption of lidocaine. Slower absorption is essential for maintaining the drug’s local effect and preventing it from rapidly entering systemic circulation.

D. Increasing systemic absorption would raise blood levels of lidocaine and increase the risk of toxicity. The purpose of adding epinephrine is to limit systemic exposure, not enhance it.

A. Trulicity (dulaglutide)is a glucagon-like peptide-1 (GLP-1) receptor agonistused to treat type 2 diabetes mellitus. It is administered via subcutaneous injection once weekly, which can cause patients or even some healthcare providers to mistakenly think it is insulin. Unlike insulin, Trulicity does not directly replace or provide exogenous insulin. Instead, it works through several mechanisms: it stimulates glucose-dependent insulin secretion, suppresses inappropriate glucagon release, slows gastric emptying, and promotes satiety, which helps reduce postprandial and fasting blood glucose. Because it is an injectable agent, proper education about its mechanism, dosing schedule, and differences from insulinis essential to prevent confusion, overdosing, or missed doses.

B. Levemir (insulin detemir)is a long-acting insulin analog. It is actual insulin, so it is not mistaken for insulin; it functions exactly like basal insulin, maintaining glucose control between meals and overnight.

C. Novolog (insulin aspart)is a rapid-acting insulinused for postprandial glucose control. Since it is true insulin, it is not a medication that is “mistaken for insulin.”

D. NPH insulin (neutral protamine Hagedorn)is an intermediate-acting insulin. Like Levemir and Novolog, it is actual insulin and therefore cannot be confused for another class of medication.