Diabetes Type 2 Diabetes 3 — Questions and Answers
Question 1: A person with type 2 diabetes on a sulfonylurea develops sweating, tremors, and confusion between meals. What is the most likely cause?
- Hyperglycemic crisis
- Hypoglycemia (Correct answer)
- Diabetic ketoacidosis
- Hyperosmolar state
Correct answer: Hypoglycemia
Sulfonylureas stimulate insulin release regardless of blood glucose levels, making hypoglycemia a significant risk, especially if meals are skipped.
Question 2: Which type of dietary fat is most associated with worsening insulin resistance in type 2 diabetes?
- Monounsaturated fats
- Polyunsaturated omega-3 fats
- Trans fats (Correct answer)
- Medium-chain triglycerides
Correct answer: Trans fats
Trans fats increase LDL cholesterol, promote inflammation, and are linked to worsened insulin resistance and increased cardiovascular risk in diabetic patients.
Question 3: What is the recommended blood pressure target for most adults with type 2 diabetes and hypertension according to the ADA?
- Less than 160/100 mmHg
- Less than 140/90 mmHg
- Less than 130/80 mmHg (Correct answer)
- Less than 120/70 mmHg
Correct answer: Less than 130/80 mmHg
The American Diabetes Association recommends a blood pressure target of less than 130/80 mmHg for most adults with diabetes to reduce cardiovascular and renal risk.
Question 4: Which finding on urine testing is an early marker of diabetic kidney disease?
- Glucosuria
- Microalbuminuria (Correct answer)
- Pyuria
- Hematuria
Correct answer: Microalbuminuria
Microalbuminuria (30–300 mg/day of albumin in urine) is an early sign of diabetic nephropathy, indicating glomerular damage before overt proteinuria develops.
Question 5: Which antidiabetic medication class has been shown to reduce hospitalization for heart failure in patients with type 2 diabetes?
- Sulfonylureas
- Thiazolidinediones
- SGLT-2 inhibitors (Correct answer)
- Alpha-glucosidase inhibitors
Correct answer: SGLT-2 inhibitors
SGLT-2 inhibitors like empagliflozin and dapagliflozin have demonstrated significant reductions in heart failure hospitalizations in cardiovascular outcome trials.
Question 6: Which metabolic condition is most closely linked to the development of type 2 diabetes and shares many underlying features?
- Hyperthyroidism
- Metabolic syndrome (Correct answer)
- Addison's disease
- Cushing's disease
Correct answer: Metabolic syndrome
Metabolic syndrome—characterized by central obesity, hypertension, dyslipidemia, and insulin resistance—shares pathophysiology with and strongly predisposes to type 2 diabetes.
Question 7: A patient with type 2 diabetes has an HbA1c of 10.5% and is symptomatic. What is the most appropriate initial treatment approach?
- Diet and exercise alone for 3 months
- Metformin monotherapy only
- Insulin therapy, with or without oral agents (Correct answer)
- Bariatric surgery referral
Correct answer: Insulin therapy, with or without oral agents
When HbA1c is significantly elevated (≥10%) with symptoms, initiating insulin is appropriate to rapidly achieve glycemic control before transitioning to oral agents.
Diabetes Type 2 Diabetes 3
A person with type 2 diabetes on a sulfonylurea develops sweating, tremors, and confusion between meals.
What is the most likely cause?