A patient with type 1 diabetes on bedtime glargine has a 03:00 glucose of 2.8 mmol/L and a fasting glucose of 9.5 mmol/L. What adjustment is most appropriate?

Increase the bedtime basal dose

Insulin glargine is best described as:

A pre-mixed biphasic insulin preparation

A rapid-acting mealtime insulin analogue

A short-acting regular human insulin

Diabetes and thyroid disorders

38 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Diabetes and thyroid disorders, part of Clinical Pharmacy and Therapeutics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
Metformin should not be used when the eGFR falls below:
1. A30 mL/min/1.73 m2
2. B75 mL/min/1.73 m2
3. C60 mL/min/1.73 m2
4. D90 mL/min/1.73 m2
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Answer: A · 30 mL/min/1.73 m2
Metformin is cleared unchanged by the kidney, and below an eGFR of 30 mL/min the risk of lactic acidosis is unacceptable. Starting is not recommended at eGFR 30-45, and the dose is reduced if it falls to that range.
- B: Metformin can be used at eGFR 75.
- C: Metformin can be used at eGFR 60.
- D: Metformin is used safely at eGFR 90.
Remember this
Avoid metformin when eGFR is below 30 mL/min/1.73 m2.
Question 2 · Medium
A patient with type 1 diabetes on bedtime glargine has a 03:00 glucose of 2.8 mmol/L and a fasting glucose of 9.5 mmol/L. What adjustment is most appropriate?
1. AAdd a morning sulfonylurea
2. BStop all insulin
3. CReduce the bedtime basal dose
4. DIncrease the bedtime basal dose
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Answer: C · Reduce the bedtime basal dose
Nocturnal hypoglycaemia followed by a high fasting value suggests rebound after overnight low glucose. Reducing the evening basal dose prevents the low and usually normalises the morning level.
- A: Sulfonylureas are not used in type 1 diabetes.
- B: Stopping all insulin is dangerous in type 1 diabetes.
- D: Increasing the dose would deepen the nocturnal hypoglycaemia.
Remember this
Low overnight glucose with a high fasting value: reduce the evening basal insulin.
Question 3 · Medium
A patient with type 2 diabetes and obesity (BMI 36 kg/m2) wants weight loss and has an HbA1c of 8.4%. Which agent gives the greatest weight reduction among these?
1. ASemaglutide
2. BSitagliptin
3. CPioglitazone
4. DGlimepiride
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Answer: A · Semaglutide
Semaglutide and tirzepatide give the largest weight loss, around 10-15% or more. Sulfonylureas and pioglitazone cause weight gain, and sitagliptin is weight-neutral.
- B: Sitagliptin is weight-neutral.
- C: Pioglitazone causes weight gain and fluid retention.
- D: Glimepiride causes weight gain.
Remember this
Semaglutide and tirzepatide give the greatest weight loss among glucose-lowering drugs.
Question 4 · Medium
A patient with CKD stage 4 (eGFR 25 mL/min) needs a DPP-4 inhibitor. Which agent needs no renal dose adjustment?
1. ALinagliptin
2. BAlogliptin
3. CSitagliptin
4. DSaxagliptin
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Answer: A · Linagliptin
Linagliptin is eliminated mainly through the bile and gut, so it needs no adjustment in renal impairment. Sitagliptin, saxagliptin and alogliptin are renally cleared and require dose reduction.
- B: Alogliptin needs dose reduction.
- C: Sitagliptin needs a reduction to 25 mg at this eGFR.
- D: Saxagliptin needs dose reduction and may raise heart failure risk.
Remember this
Linagliptin needs no renal dose adjustment.
Question 5 · Easy
Insulin glargine is best described as:
1. AA pre-mixed biphasic insulin preparation
2. BA rapid-acting mealtime insulin analogue
3. CA long-acting basal insulin
4. DA short-acting regular human insulin
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Answer: C · A long-acting basal insulin
Glargine forms microprecipitates after injection at physiological pH and is absorbed slowly over about 24 hours, giving a relatively peakless basal effect. Aspart, lispro and glulisine are rapid-acting, and regular insulin is short-acting.
- A: Biphasic insulins combine rapid and intermediate components.
- B: Rapid-acting analogues are used at meals.
- D: Regular insulin acts for 6-8 hours.
Remember this
Glargine is a long-acting basal insulin.
Question 6 · Medium
A patient with type 2 diabetes has HFrEF. Which class gives the strongest evidence of benefit on heart failure hospitalisation?
1. ASGLT2 inhibitors
2. BDPP-4 inhibitors
3. CThiazolidinediones
4. DSulfonylureas
Answer and explanation in LearnFree account
Question 7 · Medium
A patient develops gastrointestinal intolerance on metformin immediate-release 1000 mg twice daily. What is the best next step?
1. AAdd an anticholinergic
2. BSwitch to extended-release metformin
3. CStop all glucose-lowering therapy
4. DChange to a higher metformin dose
Answer and explanation in LearnFree account
Question 8 · Hard
A patient on dapagliflozin is vomiting, has a glucose of 9 mmol/L, pH 7.1, bicarbonate 8 mmol/L and ketones 5 mmol/L. What is the correct management?
1. AStop it; treat as DKA with insulin and dextrose
2. BContinue dapagliflozin and give oral fluids only
3. CGive metformin and observe the ketone trend
4. DWithhold insulin because glucose is below 11 mmol/L
Answer and explanation in LearnFree account
Question 9 · Easy
What is the standard first-line drug for most adults with newly diagnosed type 2 diabetes without contraindications?
1. AGlimepiride
2. BPioglitazone
3. CInsulin glargine
4. DMetformin
Answer and explanation in LearnFree account
Question 10 · Medium
In thyroid storm, why is propylthiouracil often preferred to methimazole?
1. AIt acts within minutes
2. BIt is less hepatotoxic
3. CIt also blocks peripheral conversion of T4 to T3
4. DIt has no effect on thyroid peroxidase
Answer and explanation in LearnFree account
Question 11 · Medium
What advice is correct about an SGLT2 inhibitor during an acute illness with vomiting and poor intake?
1. AContinue it unchanged, as intake does not matter
2. BHold it temporarily to avoid euglycaemic ketoacidosis
3. CReplace it with a sulfonylurea at a full dose
4. DDouble the dose to prevent hyperglycaemia
Answer and explanation in LearnFree account
Question 12 · Easy
The most common adverse effect of GLP-1 receptor agonists such as semaglutide is:
1. APeripheral oedema
2. BHypoglycaemia
3. CGenital candidiasis
4. DNausea
Answer and explanation in LearnFree account
Question 13 · Medium
During Ramadan fasting, a patient with type 2 diabetes measures a glucose of 3.6 mmol/L at midday. What should he do?
1. AInject rapid-acting insulin
2. BTake extra metformin
3. CContinue the fast and recheck at sunset
4. DBreak the fast and treat the hypoglycaemia
Answer and explanation in LearnFree account
Question 14 · Easy
Which antithyroid drug is preferred in the first trimester of pregnancy?
1. AMethimazole
2. BPropylthiouracil
3. CPotassium iodide
4. DCarbimazole
Answer and explanation in LearnFree account
Question 15 · Hard
A patient with type 2 diabetes takes glargine 30 units at bedtime and plans to fast during Ramadan. Applying a 20% reduction at iftar, what dose should she take?
1. A15 units
2. B28 units
3. C24 units
4. D30 units
Answer and explanation in LearnFree account
Question 16 · Medium
A pharmacist reviews a new pioglitazone prescription for a man with type 2 diabetes, ankle oedema, orthopnoea and a recent admission for heart failure. What is the main concern?
1. AFluid retention may worsen heart failure
2. BIt causes severe hypoglycaemia as monotherapy
3. CIt is renally cleared and accumulates in CKD
4. DIt raises lactic acidosis risk like metformin
Answer and explanation in LearnFree account
Question 17 · Hard
A patient with type 2 diabetes, eGFR 35 mL/min/1.73 m2 and stable on metformin 2 g daily is reviewed. What is the best action?
1. AContinue 2 g per day with monthly review
2. BStop metformin and start glibenclamide
3. CCut metformin to a maximum of 1 g daily
4. DIncrease to 3 g per day for better control
Answer and explanation in LearnFree account
Question 18 · Hard
An 80 kg adult with newly diagnosed type 1 diabetes is started on a basal-bolus regimen at 0.5 units/kg/day, half as basal. What is the daily basal insulin dose?
1. A40 units
2. B80 units
3. C10 units
4. D20 units
Answer and explanation in LearnFree account
Question 19 · Medium
A patient starting carbimazole for Graves disease should be told to report which symptoms urgently?
1. ASore throat and fever
2. BMild itching of the scalp
3. CConstipation
4. DDry mouth
Answer and explanation in LearnFree account
Question 20 · Hard
A woman stable on levothyroxine 100 micrograms starts oral oestrogen for hormone therapy, and TSH rises to 9 mIU/L after 3 months. What is the most likely explanation and action?
1. ARaised TBG; increase the dose and recheck TSH
2. BNo explanation; stop levothyroxine
3. COestrogen increases levothyroxine absorption; reduce the dose
4. DOestrogen causes thyroid autoimmunity; add antithyroid drug
Answer and explanation in LearnFree account
Question 21 · Medium
A woman with type 2 diabetes uses bedtime basal insulin and asks how to adjust it before Ramadan. What does IDF-DAR advise?
1. ATake the usual dose at suhoor unchanged
2. BDouble the dose at iftar to prevent highs
3. CStop basal insulin for the whole month
4. DTake it at iftar, reduced by 15-30%
Answer and explanation in LearnFree account
Question 22 · Medium
What is the approximate full replacement dose of levothyroxine for a healthy adult with primary hypothyroidism?
1. A5 micrograms/kg/day
2. B1.6 micrograms/kg/day
3. C10 micrograms/kg/day
4. D0.1 micrograms/kg/day
Answer and explanation in LearnFree account
Question 23 · Easy
A conscious patient on insulin has a glucose of 3.0 mmol/L with sweating and tremor. What is the immediate treatment?
1. A10 units of rapid-acting insulin
2. B15-20 g of fast-acting oral carbohydrate
3. CA large meal with fat
4. DOral metformin
Answer and explanation in LearnFree account
Question 24 · Medium
A patient taking glimepiride is found unconscious with a glucose of 1.8 mmol/L and recurs hypoglycaemic after treatment with IV dextrose. Which drug is added for persistent sulfonylurea-induced hypoglycaemia?
1. ADiazoxide
2. BOctreotide
3. CInsulin
4. DGlucagon only
Answer and explanation in LearnFree account
Question 25 · Medium
A man with type 2 diabetes and established ASCVD has an HbA1c of 7.2%. Which drug class is recommended regardless of baseline HbA1c?
1. APioglitazone for insulin sensitisation
2. BA GLP-1 RA or SGLT2i with proven CV benefit
3. CA DPP-4 inhibitor such as sitagliptin alone
4. DGlibenclamide for tighter glycaemic control
Answer and explanation in LearnFree account

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Diabetes and thyroid disorders

Metformin should not be used when the eGFR falls below:

A patient with type 1 diabetes on bedtime glargine has a 03:00 glucose of 2.8 mmol/L and a fasting glucose of 9.5 mmol/L. What adjustment is most appropriate?

A patient with type 2 diabetes and obesity (BMI 36 kg/m2) wants weight loss and has an HbA1c of 8.4%. Which agent gives the greatest weight reduction among these?

A patient with CKD stage 4 (eGFR 25 mL/min) needs a DPP-4 inhibitor. Which agent needs no renal dose adjustment?

Insulin glargine is best described as:

A patient with type 2 diabetes has HFrEF. Which class gives the strongest evidence of benefit on heart failure hospitalisation?

A patient develops gastrointestinal intolerance on metformin immediate-release 1000 mg twice daily. What is the best next step?

A patient on dapagliflozin is vomiting, has a glucose of 9 mmol/L, pH 7.1, bicarbonate 8 mmol/L and ketones 5 mmol/L. What is the correct management?

What is the standard first-line drug for most adults with newly diagnosed type 2 diabetes without contraindications?

In thyroid storm, why is propylthiouracil often preferred to methimazole?

What advice is correct about an SGLT2 inhibitor during an acute illness with vomiting and poor intake?

The most common adverse effect of GLP-1 receptor agonists such as semaglutide is:

During Ramadan fasting, a patient with type 2 diabetes measures a glucose of 3.6 mmol/L at midday. What should he do?

Which antithyroid drug is preferred in the first trimester of pregnancy?

A patient with type 2 diabetes takes glargine 30 units at bedtime and plans to fast during Ramadan. Applying a 20% reduction at iftar, what dose should she take?

A pharmacist reviews a new pioglitazone prescription for a man with type 2 diabetes, ankle oedema, orthopnoea and a recent admission for heart failure. What is the main concern?

A patient with type 2 diabetes, eGFR 35 mL/min/1.73 m2 and stable on metformin 2 g daily is reviewed. What is the best action?

An 80 kg adult with newly diagnosed type 1 diabetes is started on a basal-bolus regimen at 0.5 units/kg/day, half as basal. What is the daily basal insulin dose?

A patient starting carbimazole for Graves disease should be told to report which symptoms urgently?

A woman stable on levothyroxine 100 micrograms starts oral oestrogen for hormone therapy, and TSH rises to 9 mIU/L after 3 months. What is the most likely explanation and action?

A woman with type 2 diabetes uses bedtime basal insulin and asks how to adjust it before Ramadan. What does IDF-DAR advise?

What is the approximate full replacement dose of levothyroxine for a healthy adult with primary hypothyroidism?

A conscious patient on insulin has a glucose of 3.0 mmol/L with sweating and tremor. What is the immediate treatment?

A patient taking glimepiride is found unconscious with a glucose of 1.8 mmol/L and recurs hypoglycaemic after treatment with IV dextrose. Which drug is added for persistent sulfonylurea-induced hypoglycaemia?

A man with type 2 diabetes and established ASCVD has an HbA1c of 7.2%. Which drug class is recommended regardless of baseline HbA1c?