Diabetes

Question 1

Why is the HbA1c test preferred for diagnosing diabetes?

Answer 1

Reflects average blood glucose over 2–3 months. does not require fasting.

Question 2

How does obesity contribute to T2DM development?

Answer 2

adipose tissue releases inflammatory cytokines that exacerbate insulin resistance

Question 3

Diagnostic criteria for diabetes using FPG?

Answer 3

FPG ≥ 126 mg/dL (7.0 mmol/L)

Question 4

Primary defect in gestational diabetes

Answer 4

insulin resistance induced by placental hormones

Question 5

mechanism of sulfonylureas in type 2 DM

Answer 5

stimulate pancreatic beta cells to secrete insulin

Question 6

mechanism of metformin in improving glycemic control type 2 DM

Answer 6

decreases hepatic glucose production

metformin reduces gluconeogenesis improving insulin sensitivity

Question 7

A patient has hyperglycemia, ketosis and metabolic acidosis. What’s the possible diagnosis?

Answer 7

Diabetic ketoacidosis

lack of insulin leads to unrestrained lipolysis and ketogenesis

Question 8

How does diabetic ketoacidosis (DKA) differ from hyperosmolar hyperglycemic state (HHS)?

Answer 8

DKA involves significant ketonemia and acidosis, while HHS is marked by extreme hyperglycemia and dehydration without ketoacidosis

Question 9

What is the first-line antihypertensive in diabetic patients with albuminuria?

Answer 9

ACE inhibitors or ARBs.

These agents reduces intraglomerular pressure providing protection against diabetic nephropathy

Question 10

Pathophysiological basis of diabetic neuropathy

Answer 10

microvascular damage and oxidative stress

Question 11

pathophysiology of diabetic retinopathy

Answer 11

chronic hyperglycemia

damages the retinal microvasulature by:
1. vascular permiability
2. neovascularization due to high glucose levels

Question 12

mechanism of GLP-1 in DM

Answer 12

enhances insulin secretion and supress glucagon

Agent mimics incretin hormones leading to:
1. glycemic control
2. weight loss

Question 13

Why is hypoglycemia more common in Type 1 diabetes?

Answer 13

Absolute insulin dependence and impaired counterregulatory responses.

Question 14

Why is the dawn phenomenon observed in diabetes?

Answer 14

early morning glucose elevation due to GH and cortisol

counterregulatory hormones increase glucose production overnight

Question 15

significance of post-prandial glucose monitoring

Answer 15

reflects short-term glycemic control and predicts cardiovascular risk

Question 16

mechanism of thiazolidinediones (TZDs) in insulin sensitivity

Answer 16

activates PPAR-gamma to enhance glucose uptake in adipose tissue targeting insulin resistance in type 2 DM

Question 17

Differentiating marker of type 1 from type 2 DM

Answer 17

LOW/absent c-pep suggests type 1 DM insulin deficiency

c-peptide distinguishes between endogenous and exogenous insulin presence

Question 18

Why is screening for microalbuminuria essential in diabetes management?

Answer 18

It is an early marker of diabetic nephropathy

Question 19

threshold of Hba1c diagnostic for diabetes

Answer 19

HbA1c ≥6.5%

Question 20

diagnostic criteria for gestational diabetes mellitus

Answer 20

elevated blood glucose levels on oral glucose tolerance test (OGTT) during pregnancy

Question 21

What are the primary counter-regulatory hormones involved in hypoglycemia?

Answer 21

glucagon
epinephrine

Question 22

recommended blood pressure target for most patients with diabetes

Answer 22

<140/90 mmHg (or <130/80 mmHg in high-risk patients).

Question 23

A 45-year-old man presents with obesity and a fasting plasma glucose of 132 mg/dL. HbA1c is 6.9%. What is the next best step?

Answer 23

start metformin
R: first-line treatment for T2DM with lifestyle modifications

Question 24

glucose level diagnostic for diabetes

Answer 24

126 mg/dL (7mmol/L) and higher

Question 25

A 20-year-old woman with newly diagnosed T1DM develops abdominal pain, nausea, and rapid breathing. Lab results show pH 7.1, glucose 400 mg/dL, and serum ketones. What is the most appropriate initial treatment?

Answer 25

start IV fluids and insulin
R: patient has DKA

Question 26

A 65-year-old man with T2DM has an HbA1c of 8.2% despite metformin. He has a history of heart failure. Which medication should be added?

Answer 26

SGLT2 inhibitor

Question 27

A 58-year-old woman presents with severe hyperglycemia (glucose 850 mg/dL), dehydration, and no ketones in her urine. Which diagnosis is most likely?

Answer 27

hyperosmolar hyperglycemic state
R: without significant ketonemia or acidosis

Question 28

A 35-year-old woman with a BMI of 31 is diagnosed with gestational diabetes at 28 weeks gestation. Which of the following is the most appropriate initial management?

Answer 28

Lifestyle modifications, including dietary changes and exercise, are the first-line treatment for gestational diabetes

Question 29

A 50-year-old man with T2DM and chronic kidney disease has an HbA1c of 7.8% on metformin. Which medication is contraindicated?

Answer 29

Thiazolidinedione (TZDs)
R: it can exacerbate fluid retention worsening his condition