Diabetes Type 2

Question 1

What is the first-line treatment for type 2 diabetes?

Answer 1

Metformin (assess tolerability first).

Question 2

What if metformin is contraindicated or not tolerated?

Answer 2

Consider SGLT2 inhibitor monotherapy.

Question 3

What form of metformin may help with GI issues?

Answer 3

Metformin MR (modified release).

Question 4

Name the main oral drug classes for type 2 diabetes.

Answer 4

Metformin, SGLT2 inhibitors, DPP-4 inhibitors, Pioglitazone, Sulfonylureas.

Question 5

What are examples of SGLT2 inhibitors (‘flozins’)?

Answer 5

Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin.

Question 6

Benefits of SGLT2 inhibitors?

Answer 6

Weight loss, low hypoglycaemia risk, cardiovascular and renal protection.

Question 7

Examples of DPP-4 inhibitors?

Answer 7

Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin.

Question 8

Key considerations of DPP-4 inhibitors?

Answer 8

Weight neutral, low hypoglycaemia risk, adjust dose in renal/hepatic impairment (except some).

Question 9

What are GLP-1 mimetics indicated for?

Answer 9

If triple therapy fails and the patient is obese (BMI ≥35 or <35 with specific concerns).

Question 10

When is insulin considered?

Answer 10

When dual therapy fails to achieve glycaemic targets.

Question 11

Which medication is associated with weight gain and high hypoglycaemia risk in older people?

Answer 11

Sulfonylureas - glipizide, glimepiride, and gliclazide.

Question 12

Which medication should be avoided in heart failure or bladder cancer?

Answer 12

Pioglitazone.

Question 13

What is recommended for symptomatic hyperglycaemia?

Answer 13

Consider insulin or a sulfonylurea, and review once blood glucose is controlled.

Question 14

Examples of GLP-1 receptor agonists?

Answer 14

Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide.

Question 15

Which class is generally avoided or used cautiously in renal impairment?

Answer 15

SGLT2 inhibitors, Metformin, Sulfonylureas, and some DPP-4s.

Question 16

Which class is safest in renal impairment?

Answer 16

DDP-4 inhibitors - especially linagliptin as no dose adjustment needed.

Question 17

Which meds require caution or avoidance in hepatic impairment?

Answer 17

Most — especially SGLT2 inhibitors, Sulfonylureas, and Pioglitazone.

Question 18

What defines Type 2 Diabetes Mellitus (T2DM)?

Answer 18

A metabolic disorder with persistent hyperglycaemia due to insulin resistance and deficient insulin secretion.

Question 19

Diagnostic criteria for T2DM (adults)?

Answer 19

HbA1c ≥ 48 mmol/mol (6.5%)

OR random plasma glucose >11.1 mmol/L

OR fasting glucose ≥ 7.0 mmol/L

Question 20

Name key risk factors for T2DM.

Answer 20

Obesity, inactivity, high-risk ethnicity (Asian, African, Afro-Caribbean), family history, gestational diabetes, corticosteroid use, poor diet.

Question 21

Classic symptoms of T2DM?

Answer 21

Polyuria, polydipsia, weight loss, fatigue.

Question 22

What skin sign may indicate insulin resistance?

Answer 22

Acanthosis nigricans - a condition that causes areas of dark, thick velvety skin in body folds and creases.

Question 23

Macrovascular complications of T2DM?

Answer 23

CVD (heart disease, stroke, PAD).

Question 24

Microvascular complications of T2DM?

Answer 24

Nephropathy, retinopathy, neuropathy.

Question 25

What are the diabetic foot risks?

Answer 25

Ulcers, deformity, infection, Charcot arthropathy - a condition where bones and joints in the foot and ankle are damaged due to nerve damage (neuropathy).

Question 26

Name a psychological complication of T2DM.

Answer 26

Depression, anxiety, eating disorders.

Question 27

What can affect HbA1c accuracy?

Answer 27

Abnormal red cell turnover or haemoglobin types.

Question 28

What lifestyle interventions help T2DM?

Answer 28

Diet, exercise, weight loss, stop smoking, limit alcohol/drugs.

Question 29

HbA1c Targets for Type 2 Diabetics.

Answer 29

1. Lifestyle only / metformin - 48 mmol/mol (6.5%). 2. With sulfonylurea or insulin - 53 mmol/mol (7.0%) 3. Escalate treatment if ≥ 58 mmol/mol (7.5%). Targets be relaxed - in the elderly, frail, or at high hypoglycaemia risk.

Question 30

When is an SGLT2 inhibitor added at initiation?

Answer 30

In patients with chronic heart failure or established atherosclerotic CVD.

Question 31

hat should be considered for symptomatic hyperglycaemia - rescue therapy?

Answer 31

Insulin or sulfonylurea temporarily, then review treatment.

Question 32

Who qualifies for GLP-1 receptor agonists?

Answer 32

BMI ≥ 35 + obesity complications BMI < 35 with occupational impact or comorbidities

Question 33

When is insulin therapy introduced?

Answer 33

After dual/triple therapy fails, or in acute symptomatic hyperglycaemia.

Question 34

What defines hypoglycaemia?

Answer 34

Blood glucose < 3.5 mmol/L.

Question 35

Which treatments most commonly cause hypoglycaemia?

Answer 35

Insulin and sulfonylureas.

Question 36

What are mild symptoms of hypoglycaemia?

Answer 36

Hunger, tremor, sweating, tingling lips, palpitations, anxiety.

Question 37

What are moderate symptoms of hypoglycaemia?

Answer 37

Headache, drowsiness, confusion, blurred vision, behavioural changes.

Question 38

What defines severe hypoglycaemia?

Answer 38

Cognitive impairment, coma, convulsions — requires help from another person.

Question 39

What is impaired hypoglycaemia awareness?

Answer 39

Inability to recognise or reduced perception of hypoglycaemia symptoms.

Question 40

Managing Acute Hypoglycaemia?

Answer 40

First step if patient is conscious and able to swallow - 10–20 g of fast-acting carbohydrate (e.g., juice, glucose tablets, sugar water). Recheck blood glucose after 10–15 minutes. If glucose is restored - east a longer-acting carbohydrate (meal or snack) to prevent relapse. If unconscious or unable to swallow - give IM glucagon: 500 mcg if <8 years or <25 kg 1 mg if older/larger

Question 41

When to suspect DKA?

Answer 41

Hyperglycaemia >11 mmol/L + signs: abdominal pain, fruity breath, deep breathing (Kussmaul), ketones.

Question 42

Classic symptoms of DKA?

Answer 42

Nausea, vomiting, weight loss, SOB, confusion, drowsiness.

Question 43

Which medications should be stopped temporarily when unwell?

Answer 43

Metformin - Risk of lactic acidosis Sulfonylureas - Risk of hypoglycaemia if not eating GLP-1 analogues - Risk of dehydration side effects SGLT2 inhibitors - Risk of ketoacidosis with dehydration