Worksheets739 ME Type 2 Diabetes SBA 25-26
Total questions: 20
Worksheet time: 10mins
A 68-year-old patient with type 2 diabetes presents to the emergency department with acute pneumonia and sepsis. Their current eGFR is 25 mL/min/1.73m². They have been taking metformin 1g twice daily for 3 years. What is the most appropriate action regarding their metformin therapy?
Continue metformin at the same dose
Reduce metformin dose to 500mg once daily
Discontinue metformin immediately
Switch to modified-release metformin
Continue metformin but monitor more frequently
A 45-year-old patient with type 2 diabetes on metformin 1g twice daily requires treatment for a urinary tract infection. The GP considers prescribing trimethoprim. Which drug interaction concern should be considered?
Trimethoprim reduces metformin efficacy
Trimethoprim increases risk of lactic acidosis
Trimethoprim increases metformin plasma concentration
Trimethoprim causes vitamin B12 deficiency
No significant interaction between these drugs
A 52-year-old patient with type 2 diabetes is started on vildagliptin 50mg twice daily. According to UK prescribing guidelines, what monitoring is specifically required for this medication?
Renal function every 6 months
Liver function at 3-monthly intervals during the first year
Cardiac function assessment annually
Blood pressure monitoring monthly
Vitamin B12 levels every 6 months
A patient with a history of diabetic foot ulceration is being considered for SGLT-2 inhibitor therapy. What is the most appropriate action?
Start canagliflozin 300mg once daily
Start canagliflozin 100mg once daily with careful foot monitoring
Avoid canagliflozin due to amputation risk
Start dapagliflozin instead of canagliflozin
Wait until eGFR improves before starting any SGLT-2 inhibitor
A 62-year-old female with type 2 diabetes and a history of bladder cancer (treated 2 years ago) requests addition of pioglitazone to her current metformin therapy. What is the most appropriate action?
Start pioglitazone 15mg once daily
Start pioglitazone 30mg once daily
Pioglitazone is contraindicated due to bladder cancer history
Start pioglitazone with increased monitoring
Switch from metformin to pioglitazone
A 70-year-old patient with type 2 diabetes on gliclazide presents with confusion and sweating. Blood glucose is 2.8 mmol/L. Which characteristic of sulfonylureas makes this patient particularly vulnerable?
Sulfonylureas cause vitamin B12 deficiency in elderly
Long-acting sulfonylureas cause prolonged hypoglycaemia in elderly
Sulfonylureas interact with beta-blockers masking symptoms
Elderly patients have reduced hepatic metabolism
Sulfonylureas cause more frequent hypoglycaemia at night
A 65-year-old patient has been taking metformin 2g daily for 5 years. They present with megaloblastic anaemia and new-onset peripheral neuropathy. What is the most likely cause and appropriate action?
Lactic acidosis - stop metformin immediately
Vitamin B12 deficiency - test B12 levels and consider supplementation
Diabetic neuropathy - optimize glucose control
Drug interaction - review all medications
Metformin overdose - reduce dose
A 55-year-old male patient on dapagliflozin develops severe genital pain, erythema, and swelling with fever. He appears systemically unwell. What is the most likely diagnosis and immediate action required?
Simple urinary tract infection - prescribe antibiotics
Fournier's gangrene - stop SGLT-2 inhibitor and seek urgent medical assessment
Diabetic ketoacidosis - check ketones and blood glucose
Drug hypersensitivity reaction - prescribe antihistamines
Thrush infection - prescribe antifungal medication
A 58-year-old patient with type 2 diabetes and moderate heart failure (NYHA Class II) is being considered for DPP-4 inhibitor therapy. Which DPP-4 inhibitor should be avoided?
Sitagliptin
Linagliptin
Alogliptin
Saxagliptin
All DPP-4 inhibitors are suitable
A 45-year-old patient is starting metformin therapy. Their eGFR is 42 mL/min/1.73m². What is the most appropriate metformin dosing strategy?
Start standard dose 500mg three times daily
Start reduced dose and review when eGFR improves
Metformin is contraindicated - choose alternative
Start modified-release preparation only
Start 250mg once daily and titrate slowly
A 62-year-old patient on gliclazide requires treatment for a fungal infection. The doctor prescribes fluconazole. What precaution should be taken?
No interaction - both drugs can be used together
Monitor for increased risk of hypoglycaemia
Monitor for reduced gliclazide effectiveness
Switch to a different antifungal agent
Increase gliclazide dose during fluconazole treatment
A 60-year-old patient with type 2 diabetes has an eGFR of 35 mL/min/1.73m². Which SGLT-2 inhibitor can still be initiated at this renal function level?
Canagliflozin 100mg
Empagliflozin 10mg
Ertugliflozin 5mg
Dapagliflozin 10mg
No SGLT-2 inhibitors should be initiated
A 55-year-old patient started on pioglitazone 15mg daily requires specific monitoring. Which parameter is most important to assess before and during treatment?
Renal function every 3 months
Liver function tests and signs of heart failure
Blood pressure and lipid profile
Vitamin B12 levels annually
Thyroid function tests
A 50-year-old patient on sitagliptin develops severe abdominal pain, nausea, and vomiting. Serum amylase is elevated. What is the most likely diagnosis and appropriate action?
Diabetic ketoacidosis - check blood ketones
Acute pancreatitis - stop sitagliptin and seek urgent assessment
Gastroenteritis - provide supportive care
Hypoglycaemia - check blood glucose
Drug interaction - review all medications
A patient on metformin is prescribed verapamil for hypertension. How might this combination affect diabetes management?
Increased risk of lactic acidosis
Reduced metformin efficacy requiring dose adjustment
Increased metformin plasma levels
No significant interaction expected
Enhanced hypoglycaemic effect
A 65-year-old patient with type 2 diabetes and hypertension is on empagliflozin and bendroflumethiazide. They present with dizziness and postural hypotension. What is the most likely cause?
Diabetic neuropathy causing autonomic dysfunction
Hypoglycaemia from drug interaction
Volume depletion from additive diuretic effects
Allergic reaction to empagliflozin
Worsening heart failure
A 70-year-old patient with type 2 diabetes has an eGFR of 25 mL/min/1.73m². Their current gliclazide is causing frequent hypoglycaemic episodes. What is the most appropriate management?
Continue gliclazide but reduce dose
Switch to glibenclamide for longer action
Discontinue sulfonylurea due to increased hypoglycaemia risk
Add metformin to reduce hypoglycaemia risk
Switch to modified-release gliclazide
A 45-year-old newly diagnosed patient with type 2 diabetes has no cardiovascular disease and normal renal function (eGFR 85 mL/min/1.73m²). What is the most appropriate first-line treatment according to current UK guidelines?
Metformin monotherapy
SGLT-2 inhibitor monotherapy
Metformin plus SGLT-2 inhibitor dual therapy
Metformin plus DPP-4 inhibitor
Lifestyle modification only
A patient on gliclazide asks about taking St John's Wort for low mood. What advice should be given regarding this herbal preparation?
St John's Wort is safe to use with gliclazide
St John's Wort may cause poor blood glucose control
Reduce gliclazide dose when starting St John's Wort
Monitor for increased hypoglycaemia risk
Switch to metformin before starting St John's Wort
A 72-year-old patient with type 2 diabetes, chronic heart failure, and eGFR 28 mL/min/1.73m² is currently on metformin 500mg twice daily. Their HbA1c is 75 mmol/mol. What is the most appropriate next step?
Increase metformin dose to 1g twice daily
Stop metformin and start insulin
Add gliclazide to current metformin
Stop metformin, start empagliflozin for heart failure benefit
Continue current therapy and lifestyle advice only
