DM for medical students

In a patient with T2DM and established atherosclerotic cardiovascular disease (ASCVD) or high ASCVD risk, which drug class should be considered first?

• Metformin

• Sulfonylureas

• GLP-1 RA or SGLT2i

• DPP-4 Inhibitors

Answer explanation

In patients with T2DM and high ASCVD risk, GLP-1 receptor agonists (RA) or SGLT2 inhibitors (i) are preferred first-line due to their cardiovascular benefits, regardless of initial HbA1c levels.

Which diabetes medication is most associated with a high risk of hypoglycemia?

• Metformin

• SGLT2i

• Sulfonylureas

• DPP-4 Inhibitors

Answer explanation

Sulfonylureas are known to stimulate insulin release from the pancreas, which can lead to a significant risk of hypoglycemia. In contrast, Metformin, SGLT2 inhibitors, and DPP-4 inhibitors have a lower risk of causing low blood sugar.

Which diabetes medication should be avoided in patients with heart failure?

• Thiazolidinediones

• Metformin

• GLP-1 RA

• SGLT2i

Answer explanation

Thiazolidinediones should generally be avoided in patients with heart failure with reduced ejection fraction (HFrEF) due to their potential to cause fluid retention, worsening heart failure symptoms.

Which of the following is NOT a common side effect of Metformin?

• Nausea

• Weight gain

• Lactic acidosis

• Diarrhea

Answer explanation

Weight gain is not a common side effect of Metformin; in fact, it often leads to weight loss. Nausea, diarrhea, and lactic acidosis are known side effects associated with this medication.

Which of the following is NOT a recognized benefit of SGLT2 Inhibitors?

• Cardiovascular disease (CVD) risk reduction

• Improvement in insulin sensitivity in peripheral tissues

• Reduction in heart failure (HF) hospitalization

• Slowing of chronic kidney disease (CKD) progression

Answer explanation

SGLT2 inhibitors primarily benefit cardiovascular health, heart failure, and kidney function. They do not significantly improve insulin sensitivity in peripheral tissues, making this the correct choice.

According to current guidelines, what is the most common initial insulin type recommended for patients with Type 2 Diabetes when insulin therapy is needed?

• Basal insulin

• Premixed insulin

• Mealtime (bolus) insulin

• Intravenous insulin

Answer explanation

Current guidelines widely recommend initiating basal insulin as the first step for most Type 2 Diabetes patients requiring insulin, due to its effectiveness in controlling fasting glucose.

Which of the following statements is NOT generally true about DPP-4 Inhibitors?

• They carry a high risk of hypoglycemia as monotherapy.

• They primarily work by enhancing incretin hormone effects.

• They are oral medications.

• They are weight-neutral.

Answer explanation

DPP-4 inhibitors do not carry a high risk of hypoglycemia as monotherapy, making this statement NOT generally true. They enhance incretin effects, are oral medications, and are considered weight-neutral.

How should unopened insulin be stored to maintain its efficacy until the expiration date indicated on the label?

• At room temperature

• In the freezer

• In the refrigerator, at 2-8 degrees Celsius

• In a dark and dry place, no refrigeration needed

Answer explanation

Unopened insulin should be stored in the refrigerator at 2-8 degrees Celsius to maintain its efficacy until the expiration date. Other storage methods can compromise its effectiveness.

Why should diabetic patients who inject insulin regularly rotate their injection sites?

• To reduce the risk of infection

• To make the drug act faster

• To prevent lipohypertrophy and ensure good drug absorption

• To reduce injection pain

Answer explanation

Diabetic patients should rotate injection sites to prevent lipohypertrophy, which can occur from repeated injections in the same area. This helps ensure consistent drug absorption and effectiveness.

Which of the following statements best explains why prandial insulin is necessary for many patients with diabetes, even if they are on basal insulin?

• Basal insulin cannot fully suppress gluconeogenesis from the liver.

• Prandial insulin is needed to cover the rapid rise in blood glucose after carbohydrate-containing meals.

• Basal insulin has a very short duration of action, requiring prandial insulin for sustained control.

• Prandial insulin helps prevent hypoglycemia between meals.

Answer explanation

Prandial insulin is necessary because it specifically addresses the rapid increase in blood glucose levels that occurs after meals, which basal insulin alone cannot adequately manage.