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Diabetes 2

Total questions: 55

Worksheet time: 29mins

Name
Class
Date
1.

Depolarization of pancreatic β-cells leads to:

a)

Inhibition of glucagon secretion

b)

Potassium efflux

c)

Insulin secretion

d)

Closure of calcium channels

2.

In resting β-cells, ATP levels are low and K⁺ channels remain open. What happens after glucose entry?

a)

ATP increases, closing K⁺ channels and triggering Ca²⁺ influx

b)

ATP decreases, opening K⁺ channels and triggering Ca2+ influx

c)

ADP increases, maintaining membrane hyperpolarization

d)

Calcium channels remain closed

3.

Which insulin modification contributes to long-acting pharmacokinetics?

a)

B28 Pro → Asp substitution

b)

Addition of myristic acid to B29Lys

c)

B29 Lys → Pro substitution

d)

AsnA21 → Gly substitution only

4.

Lispro differs from human insulin by:

a)

B28 Pro → Lys and B29 Lys → Pro

b)

Addition of arginine residues at B31 and B32

c)

Removal of B30Thr

d)

Addition of myristic acid chain

5.

Which insulin is formulated to precipitate at physiological pH?

a)

Aspart

b)

Glulisine

c)

Glargine

d)

Detemir

6.

Which adverse effect of insulin therapy results from repeated use of the same injection site?

a)

Hypoglycemia

b)

Lipodystrophy

c)

Ketoacidosis

d)

Hyperkalemia

7.

Pramlintide is classified as a(n):

a)

GLP-1 agonist

b)

Amylin analog

c)

DPP-4 inhibitor

d)

Sulfonylurea

8.

Which of the following is the longest acting GLP-1 agonist?

a)

Exenatide

b)

Liraglutide

c)

Dulaglutide

d)

Semaglutide

9.

Which of the following is approved for T2DM and weight management?

a)

Tirzepatide

b)

Liraglutide

c)

Exenatide

d)

Dulaglutide

10.

Which functional group in saxagliptin contributes to its pseudo-irreversible inhibition of DPP-4?

a)

Hydroxyl group

b)

Amine group

c)

Cyano group

d)

Amide bond

11.

Sulfonylureas act by binding to which target?

a)

SUR1 subunit of K⁺/ATP channels

b)

DPP-4 enzyme

c)

SGLT2 transporter

d)

α-Glucosidase enzyme

12.

Which first-generation sulfonylurea has the longest half-life and is contraindicated in the elderly?

a)

Tolbutamide

b)

Chlorpropamide

c)

Glyburide

d)

Glimepiride

13.

Which statement correctly distinguishes first- and second-generation sulfonylureas?

a)

Second-generation have smaller R₁ substituents

b)

Second-generation are less potent

c)

Second-generation have bulkier R₁ groups, increasing receptor affinity

d)

First-generation have longer half-life

14.

Pioglitazone lowers blood glucose primarily by:

a)

Increasing insulin secretion

b)

Blocking DPP-4

c)

Activating PPAR-γ

d)

Decreasing carbohydrate absorption

15.

Which of the following is not an adverse effect of thiazolidinediones?

a)

Weight gain

b)

Fluid retention

c)

Hepatotoxicity

d)

Hypoglycemia

16.

SGLT2 inhibitors lower plasma glucose by:

a)

Reducing hepatic gluconeogenesis

b)

Blocking renal glucose reabsorption

c)

Increasing insulin secretion

d)

Enhancing incretin activity

17.

Metformin decreases blood glucose by all of the following except:

a)

Increasing gluconeogenesis

b)

Decreasing glycogenolysis

c)

Increasing glucose uptake

d)

Decreasing lipolysis

18.

Metformin should be avoided in patients with:

a)

Hypertension

b)

COPD

c)

Severe renal or hepatic impairment

d)

Obesity

19.

Which α-glucosidase inhibitor prevents digestion of complex carbohydrates in the intestine?

a)

Sitagliptin

b)

Acarbose

c)

Pioglitazone

d)

Liraglutide

20.

Patients taking α-glucosidase inhibitors who develop hypoglycemia should be treated with:

a)

Sucrose

b)

Glucose

c)

Starch

d)

Fatty meal

21.

Which two peptide hormones work synergistically with insulin to regulate post-prandial glucose?

a)

Glucagon and amylin

b)

Amylin and incretins

c)

Glucagon and cortisol

d)

Epinephrine and ghrelin

22.

Which amino acid residue in insulin can be modified without significant loss of activity?

a)

GlyB23

b)

AsnA21

c)

PheB24

d)

TyrB26

e)

PheB25

23.

What stabilizes insulin in solution by promoting hexamer formation?

a)

Zinc ions

b)

Sodium chloride

c)

Niacinamide

d)

Arginine

24.

Which insulin analog removes B30 Thr and adds a hexadecanedioic acid chain to B29Lys?

a)

Glargine

b)

Detemir

c)

Degludec

d)

Lispro

25.

Which long-acting insulin precipitates at physiological pH due to added Arg residues?

a)

Lispro

b)

Glargine

c)

Aspart

d)

Detemir

26.

Which enzyme inactivates GLP-1 in the body?

a)

α-glucosidase

b)

DPP-4

c)

PARP

d)

SGLT2

27.

Which incretin increases insulin and decreases glucagon after meals?

a)

GIP

b)

GLP-1

c)

Amylin

d)

Somatostatin

28.

Which DDP-4i is excreted mainly in the feces?

a)

Sitagliptin

b)

Saxagliptin

c)

Linagliptin

d)

Alogliptin

29.

Metformin acts primarily by:

a)

Blocking DPP-4

b)

Inhibiting hepatic gluconeogenesis

c)

Stimulating β-cell insulin release

d)

Blocking intestinal glucose absorption

30.

Metformin is classified as a(n):

a)

Sulfonylurea

b)

Biguanide

c)

Glitazone

d)

Gliptin

31.

Which of the following is not a common side effect of metformin?

a)

GI discomfort

b)

Vitamin B₁₂ deficiency

c)

Weight gain

d)

Metallic taste

32.

α-Glucosidase inhibitors act by:

a)

Reducing renal glucose reabsorption

b)

Blocking intestinal carbohydrate digestion

c)

Increasing insulin release

d)

Activating PPAR-γ

33.

Which is true about miglitol?

a)

It is a DPP-4 inhibitor

b)

It is a GLP-1 agonist

c)

It is an α-glucosidase inhibitor

d)

It is an SGLT2 inhibitor

34.

Which SGLT2 inhibitor was the newest FDA-approved member (Dec 2017)?

a)

Canagliflozin

b)

Dapagliflozin

c)

Empagliflozin

d)

Ertugliflozin

35.

Which of the following is not a complication of diabetes?

a)

Nephropathy

b)

Gangrene

c)

Glaucoma

d)

Low blood pressure

36.

Type 1 Diabetes is characterized by:

a)

Insulin resistance with obesity

b)

Autoimmune destruction of β-cells

c)

Increased insulin levels

d)

Adipocyte hypertrophy

37.

Type 2 Diabetes typically involves which of the following stages?

a)

Only β-cell destruction

b)

Insulin resistance followed by β-cell exhaustion

c)

Glucagon deficiency

d)

Increased lipolysis only

38.

Which biochemical change is associated with DKA?

a)

Low glucose, alkalosis

b)

High glucose > 250 mg/dL, low pH < 7.2, high ketones

c)

Hypokalemia and hypoglycemia

d)

Low bicarbonate > 25 mEq/L

39.

Place the following stages in the pathophysiology of Type 2 Diabetes Mellitus in the correct order:

a)

Insulin resistance in tissues

b)

Increased insulin demand

c)

Beta-cell exhaustion

d)

Hyperglycemia

1)
2)
3)
4)
40.

What role do Gliflozins (like Dapagliflozin - Farxiga) play in managing diabetes?

a)

Stimulate insulin secretion from pancreatic beta cells

b)

Increase insulin sensitivity in tissues

c)

Block glucagon secretion

d)

Inhibit glucose reabsorption in the kidneys

41.

Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) work by increasing endogenous incretin levels and decreasing plasma glucose.

a)

True

b)

False

42.

Which statement best describes the function of the insulin receptor (IR)?

a)

A G-protein–coupled receptor that inhibits adenylate cyclase

b)

A tyrosine-kinase receptor that phosphorylates IRS-1 to activate anabolic pathways

c)

A ligand-gated ion channel that allows Ca²⁺ entry

d)

A serine/threonine phosphatase

43.

Insulin activation of GLUT4 primarily increases glucose uptake in:

a)

Brain and liver

b)

Skeletal muscle and adipose tissue

c)

Renal tubules and GI epithelium

d)

Erythrocytes and neurons

44.

Which of the following correctly matches the peptide hormone with its major role?

a)

GLP-1 → ↑ glucagon

b)

GIP → ↓ insulin

c)

Amylin → slows gastric emptying and suppresses post-prandial glucagon

d)

Somatostatin → stimulates insulin release

45.

Which incretin-based drug would be least affected by renal impairment?

a)

Sitagliptin

b)

Saxagliptin

c)

Linagliptin

d)

Alogliptin

46.

Which dual receptor agonist targets both GLP-1 and GIP receptors?

a)

Exenatide

b)

Dulaglutide

c)

Tirzepatide

d)

Semaglutide

47.

Metformin’s rare but serious adverse effect is:

a)

Ketoacidosis

b)

Lactic acidosis

c)

Stevens–Johnson syndrome

d)

Pancreatitis

48.

hich vitamin deficiency can result from chronic metformin therapy?

a)

Vitamin B₆

b)

Vitamin B₁₂

c)

Folic acid

d)

Vitamin D

49.

Which class should be avoided with contrast media procedures due to renal stress risk?

a)

SGLT2 inhibitors

b)

Thiazolidinediones

c)

Biguanides

d)

Sulfonylureas

50.

Which statement best explains why α-glucosidase inhibitors don’t cause hypoglycemia alone?

a)

They increase insulin release only during fasting

b)

They delay carbohydrate absorption without affecting basal glucose production

c)

They block insulin receptors

d)

They stimulate glucagon release

51.

Why must α-glucosidase inhibitors be taken with the first bite of a meal?

a)

They require acidic activation

b)

They act locally to prevent carbohydrate digestion in the intestine

c)

They are inactivated by insulin

d)

They slow gastric emptying

52.

Which adverse effect is most associated with SGLT2 inhibitors?

a)

Severe hypoglycemia

b)

Genitourinary infections

c)

Weight gain

d)

GI bleeding

53.

Which molecule build up causes fruity breath?

a)

Acetoacetate

b)

β-hydroxybutyrate

c)

Acetone

d)

Lactate

54.

Which two classes contribute to weight loss in Type 2 diabetes patients?

a)

SGLT2 inhibitors and Insulin

b)

Sulfonylureas and Glitazones

c)

GLP-1 agonists and Amylin

d)

Glinides and Biguanides

55.

Which of the following classes are considered "weight neutral"?

a)

Metformin

b)

DPP4 inhibitors

c)

Amylin

d)

Insulin

e)

Thiazolodinediones

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