Diabetes related quiz and related explanations

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DIABETES QUIZ
Dr J Rangwala
Sr Consultant Diabetologist
Narayana Multispeciality Hospital

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DIABETES QUIZ: 1
● A Vial of Insulins / Analog contains:
A) 40U / ml
B) 100U / ml
C) A and B both
D) 40U / Vial
Insulin is available in Vials and Cartridges:
Vials are available in 40U/ml and 100U/ml, where as
Cartridges are available in 100U/ml

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Quiz : 2
● One penfill of Insulin contains:
A) 300U
B) 1000U
C) 500U
D) 400U
One penfill of Insulin contains 300U of Insulin in concentration of 100U/ml

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Quiz : 3
● Insulin can be kept at room temperature,
outside refrigerator for:
A) 1 day
B) 4 days
C) 2 weeks
D) 4 weeks
Insulin in use, vial or pen can be kept at cool place even at room
temperature for about 4 weeks
Where as
Insulin (stock) which is NOT in current use should be kept in LOWER
panel of refrigerator.

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QUIZ : 4
● What is the strength of Insulin in pens?
A) 40 U / ml
B) 100 U / ml
C) 300 U / ml
D) 30 : 70 U /ml
Strength of Insulin in Penfills / Cartridges is 100 U / ml
Each penfill of Insulin contains 300 Units of Insulin.

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Quiz : 5
● Human Regular Insulin injection should be
given usually:
A) Along with food
B) Soon after the food
C) Half hour before food
D) One hour before food
Human Regular Insulins should be injected 30 – 45 minutes before meals
Whereas
Rapid acting analogues can be injected 0 – 15 minutes before meals

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Quiz : 6
● If a patient is mixing 2 types of insulin in same
syringe, which insulin should be taken first in
the syringe?
A) Any insulin
B) Short Acting
C) NPH
D) Rapid acting
It is important that while mixing two types of Insulin,
Short acting insulin must be loaded first inthe syringe
followed by intermediate acting insulin like NPH

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QUIZ : 7
● Length of currently available Ultrafine 31G
needle for 100 U / ml syringe is:
A) 8 mm
B) 6 mm
C) 12.77 mm
D) 5 mm
In India 31G needle length for for 100U syringe is 8 mm.
Where as 31G needle length for 40U syringe has 6 mm.
And 31G needle length for Pens is 4, 4.5, 5, 6mm.

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Quiz : 8
● Which one of the criteria should be met to
establish diagnosis of Diabetes:
A) Symptoms of Diabetes and Random plasma glucose of
< 200 mg / dl
B) Fasting plasma glucose = 126 mg/dl with No calorie
intake for atleast 8 hours.
C) 2 hours plasma glucose = 180 mg/dl during OGTT with
75 gm glucose with water
D) None of the above.
According to ADA guideline: one of the four criterion must be applied:
1. FBS > 126 mg/dl with No caloric intake for atleast 8 hours
2. Symptoms of Diabetes + RBS > 200 mg/dl
3. PP2BS > 200 mg/dl during OGTT with 75 gm glucose with water
4. HbA1c > 6.5

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Quiz : 9
● Which of the statement in relation to Type 2 DM
is not true:
A) Type 2 DM is commonest form of Diabetes
B) Type 2 DM is usually part of metabolic syndrome
C) Genetic predisposition accounts for < 20% susceptibility
to Diabetes.
D) Ketosis is infrequent
Type 2 DM is commonest form of Diabetes and
is usually a part of Metabolic syndrome.
It is characterised by Insulin Resistance and relative insulin deficiency.
Genetic predisposition accounts for 40 – 80% of cases of Type 2 DM.
Ketosis is usually seen in Type 1 DM due to absolute insulin deficiency.

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Quiz : 10
● Which statement is not true in relation with normal physiology
of insulin secretion:
A) In fasting stat insulin is secreted in pulsatile manner every 10 – 14
minutes.
B) After food there is early burst of insulin release in first 10 minutes, followed
by 2nd
phase of insulin release, which reaches to plateau.
C) In Diabetes, initially 2nd
phase of insulin release gets affected
D) In Type 2 DM there is defect of insulin release as well as insulin action.
Type 2 DM is characterised by both Insulin resistance and deficiency of insulin.
Primary stimulus for insulin secretion is the beta cell response to changes in ambient
glucose. Normally, glucose induces a biphasic pattern of insulin release.
First phase insulin release occurs within the first few minutes, after exposure to an elevated
Glucose level, this is followed by a more enduring second phase of insulin release.
Of particular Importance is the observations that first phase of insulin secretion is lost in
patient with early early Type 2 DM

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Quiz : 11
● What is true regarding monotherapy with
Metformin:
A) Metformin stimulates pancreas to secreat Insulin
B) Can be given in patient even with S. Creatinine upto 4
mg%
C) Metformin is usual 1st
line agent in Type 2 DM
D) Metformin can even be prescribed to Type 1 DM
Metformin is usually 1st
line drug for treatment of overweight Type 2 DM.
Primary biological effect of Metformin includes decrease in hepatic glucose production
and enhance insulin efects in muscle and fat (Sensitizer).
It has got no direct effect on beta cell function.
It is contraindicated in patients with S Creatinne > 1.5 mg/dl for the fear of lactic acidosis.
Since Type 1 DM is characterised by absolute insulin deficiency, metformin has no role
In management of Type 1 DM

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Quiz : 12
● All the drug belong to same category except
one:
A) Acarbose
B) Repaglinide
C) Miglitol
D) Voglibose
Acarbose, Miglitol and Voglibose are alpha glucosidase inhibitors and prevent / delay
Digestion of carbohydrates of diet ingested. Repaglinide is non sulphonyl urea
Secretagouge and has shorte duration of action.
Both groups (Alpha glucosidase inhibitors and Glinides) are used mainly to lower
post prandial blood sugar.

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Quiz : 13
● Which group of drug act by acting on glucose
dependent Insulin :
A) DPP4 inhibitors
B) Sulfonylureas
C) Alpha glucosidase inhibitors
D) Glinides
GLP-1 is rapidly inactivated by DPP4 enzyme. DPP4 inhibitors thus increase level of
GLP-1 in the blood.
GLP-1 in turns results in glucose dependent insulin secretion.
SU and Glinide cause glucose independent insulin secretion from pancreas.
Alpha glucosidase inhibitors delay or prvent digestion of carbohydrate from the diet
And has no direct effect on insulin secretion from beta cells.

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Quiz : 14
● What is not true regarding sick day rules:
A) Insulin requirement goes down during sickness hence it
may be temporarily stopped.
B) Ask the patient to measure glucose regularly.
C) Ask the patient to drink plenty of water if patient cannot
eat.
D) If patient is vomiting , ask him to consult doctor.
It is important to educate patient with Type 1 DM about sick days rule.
During any sickness usually insulin requirement goes up and hence patient with Type 1 DM
Should be instructed to continue taking insulin and monitor blood sugar, even
during sickness. Omission of insulin during sickness may result in Diabetic Ketoacidosis.

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Quiz : 15
● According to ADA what should be the frequency
of self monitoring of blood glucose for patients
using multiple insulin injections or insulin pump
therapy:
A) > 3 times per day
B) 2 times a day for 2 consecutive days of a week
C) 3 times a day for 3 times a week
D) Weekly once
According to ADA guidelines patients using multiple insulin injections or
insulin pump therapy should check their fasting plasma glucose and
all premeal plasma glucose

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Quiz : 16
● What is not true about LDL:
A) As number of LDL particle increases in plasma, risk of
CVD increases.
B) Risk of premature CVD is directly related to particle size,
larger the particle, higher the risk
C) An adult with overt CVD, the LDL goal is < 70 mg/dl
D) Normally LDL to HDL ratio should be kept below 3
Statin targeted LDL therapy is key factor in management of dyslipedemia in DM.
In DM certain unique changes occur in LDL.
LDL in Diabetes becomes smaller and denser, gets oxidised and particle number
increase.
All these factors, confers greater risk for CVD in Diabetes.
Smaller the LDL particles, larger is the risk for premature CVD.

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Quiz : 17
● For concious patient with hypoglycemia how
much glucose should be given by mouth to
overcome it:
A) 25-30 gm
B) 15-20 gm
C) 10 gm
D) 250 gm
Hypoglycemia in conscious individual can be easily managed by giving
15-20 gms of glucose orally

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Quiz : 18
● What is most important priority in management
of DKA:
A) Insulin infusion
B) Correction od dehydration and restoration of blood
volumes
C) Correction of electrolyte imbalance
D) Broad spectrum antibiotics.
In DKA, due to osmotic diuresis there is severe dehydration resulting
in significant loss of water and electrolyte.
The priority in management of DKA is restoration of cirulatory volume
by correcting dehydration.
Other aspects of management includes insulin infusion, correction of
electrolyte imbalance and correction of precipitating factors if any.

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Quiz : 19
● What is normal cut off for waist hip ratio (WHR)
in male and female?
A) Male < 0.90 and female < 0.85
B) Male < 0.95 and female < 0.90
C) Male < 0.85 and female < 0.90
D) Male < 0.80 and female < 0.85
As per WHO, abdominal obesity is defined as WHR of > 0.90 for males, > 0.85 for
Females or BMI > 30.
Hence normal cuttof of WHR is < 0.90 for males and < 0.85 for females.

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Quiz : 20
ABI is ratio of blood pressure as measured on dorsalis pedis and brachial artery.It
is sensitive indicator of arterial blood flow in lower limb.Normal brachial index is >
0.96.ABI < 0.9 indicates peripheral arterial disease
● Which statement is not true for ABI (Ankle
Brachial Index):
A) It is ratio of blood pressure as measured on dorsalis
pedis and brachial artery.
B) It is sensitive indicator of arterial blood flow in lower limb.
C) Normal brachial index is < 0.96
D) ABI < 0.9 indicates peripheral arterial disease

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QUIZ : 21
● Which statement is false :
A) Soluble insulin is colorless and should be given 20 – 30
minute prior to meals
B) Isophane Insulin (NPH) is intermediate acting and is also
colorless
C) Glargine is long acting insulin and is colorless
D) Glargine cannot be mixed with Actrapid in the same
syringe
Conventional regular / soluble insulin, rapid acting insulin analogue and Glargine
Are colorless in appearance, where as NPH is milky in appearance.
Soluble insulin can be mixed with NPH in the same syringe, whereas Glargine
cannot be mixed with soluble insulin.

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Quiz : 22
● What is meant by the term Gluconeogenesis?
A) Conversion of glucose to glycogen
B) Conversion of glycogen to glucose
C) Sysnthesis of glucose from non glucose sources
D) Utilisation of glucose by cells
Gluconeogenssis refers to synthesis of glucose from non glucose sources like
Amino acids, fatty acids etc. Insulin inhibits gluconeogenesis.
Glycolysis refers to utilisation of glucose by tissues.
Glycogenesis refers to synthesis of glycogen from glucose.
Glycogenolysis refers to breakdown of stored glycogen.

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Quiz: 23
● What is the rationale behind the cut off value of fasting
plasma sugar in diabetes?
A) It indicates sharp increase in macrovascular complication beyond
that value
B) It indicates sharp increase in microvascular complication beyond
that value
C) It indicates the level beyond which glucose starts to appear in
urine.
D) It is emperic value.
The cut off for normal fasting plasma has been taken as beyond this level there is
Sharp increase in macrovascular complications.

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Quiz : 24
● Patient R K, has recent onset of DM, his BMI 20.2 ,
FBS 100 mg/dl, PP2BS 245 mg/dl, which therapy will
be most appropriate with LSM
A) Glimiperide 1 mg
B) Glimiperide 2 mg
C) Repaglinide 0.5 mg with major meals
D) Gliclazide SR 30 mg
The predominat abnormality here is high PP2BS and normal FBS,
in lean body weight.
Adding Repaglinide is best choice as it will normalise post prandial sugar
without causing nocturnal hypoglycemia.
Repaglinide is non SU secretagouge with shorter duration of action.
SU will normalize post prandial sugar but it will also reduce fasting level too
Which may induce nocturnal hypoglycemia in this case as his FBS is normal

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Quiz : 25
● Patient R K, DM since 7 months with BMI 31.2, on
Metformin 1 G / day. His recent FBS 110 mg /dl and
PP2BS 250 mg/dl, what is most appropriate to add on:
A) Add Glimiperide 1 mg
B) Add Pioglitazone 30 mg
C) Add DPP4 inhibiotr and increase dose of Metformin
D) Add Gliclazide SR 30 mg
RK has new onset DM with high BMI, despite on Metformin his Post prandial level is high.
Adding DPP4 inhibiotr and increasing Metformin dosage will be appropriate as it will not
Increase weight , preserve beta cell if any, and will not induce risk of hypoglycemia.
SU may lead to weight gain and induce risk of hypoglycemia.
Pioglitazone will also lead to weight gain.

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Quiz : 26
● Patient K K, DM since 10 yrs with BMI 29.2, on Glimi 4 mg/day,
Metformin 1 G/day. His FBS 160 md/dl and PP2BS 260 mg/dl, Urine
ACR 215 microgm/mg, BP 130/80, has moderate NPDR.what will be
most appropriate strategy?
A) Uptitrate Glimi to 6 mg + Metformin 1500 mg + Pio 15 mg
B) Discuss with patient to start Insuin and add ACEI / ARB
C)Uptitrate Glimi to 6 mg + Metformin 1500 mg + Pio 15 mg + ACEI / ARB
D)Advice protein restriction.
KK has stage 3 Nephropathy, NPDR, is on near max dose of OAD, and still ha uncontrolled
Sugar. He is an ideal candidate for intensive insulin therapy and should be educated and
discuss regarding same. In view of Nephropathy ACEI / ARB should also be added.

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Quiz : 27
● Which statement regarding monofilament
examination is not true:
A) It is used to detect high risk foot
B) It should be applied perpendicular to the skin till it bends
C) It used to detect sensation of touch
D) Total duration of approach, skin contact and departure of
MF at each site should be 1 – 2 seconds
MF examination is meant to detect pressure sensation and loss of MF sensation helps
To identify high risk foot for diabetic ulcers.
The correct technique is crucial, as total duration of approach, skin contact and departure
Of MF at each site should be 1 -2 seconds.

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Quiz : 28
● Which of the following statement is incorrect?
A) Neuropathy occurs on pressure points / bony
prominence
B) Neuropathy occurs on dorsum / tip of toe / between toe
C) Blisters are commonly seen in association with
neuropathic ulcers
D) In ischemic ulcers claudication pain may be present
initially, later rest pain
Diabetic foot ulcers are classified into vascular and neuropathic. Neuropathic ulcers are
Usually present on pressure points / bony prominences, there may be associated blisters
And loss of sensation.
Vacular ulcers are commonly occur on dorsum / tip of the toe / between toe and
may be associated with claudication pain

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Quiz : 29
● Which one of the following statement is correct
regarding GLP 1 analouge?
A) Decreases glucose dependent insuli secretion
B) Decreases postprandial glucagon secretion
C) Reduces gastric emptying time
D) Increases satiety.
GLP 1 is hormone secreted by gastrointestinal tract from L cells inresponse to ingestion
Of oral glucose.
It increases glucose dependent insulin secretion from beta cells, decreases glucagon
Secretion from alpha cells, reduces gastric emptying, and induces satiety.

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Quiz : 30
● Which statement in relation to Type1 DM is
false?
A) Type 1 DM patients are generally young and lean
B) Usually they have less marked osmotic symptoms
C) They are more prone to Ketoacidosis
D) They present with sudden appearance of weight loss
Type 1 DM are usually lean, young, present with sudden onset of weight loss,
and have marked osmotic symptoms
They are more prone to Diabetic Ketoacidosis.
All these is because of rapid autoimmune destruction of B cells of pancreas.

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Quiz : 31
● Which type of Insulin therapy is considered best
for the management of Type 1 DM?
A) Premixed Insulin
B) Basal – Bolus – Intensive Insulin Therapy
C) Only Glargine as risk of Hypoglycemia is low
D) Day time short acting and evening Premixed
E) Basal – Plus with main meals
Principal Management of Type 1 DM is based on physiologic replacement of Insulin.
Best strategy to treat is Insulin either by Insulin pump or Basal – bolus Insulin regimen
With Insulin analouges preferably.
Treatment of Type 1 DM with Premixed Insulin is no longer considered standard of care

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Quiz : 32
● Mr ABC with 32.3 BMI on Met 500 + 15 mg Pioz +
Glimi 2 mg twice daily since 2 years. He has
concern for weight gain of 5 kgs since 1 yrs and has
Bilateral Pedal Edema and has good Glycemic
control, what needs to be done?
A) Add Diuretic for pedal edema
B) Advice salt restriction and physical exercise to reduce weight
C) Omit Pioglitazone
D) To investigate for Diabetic Nephropathy
Glitazones is known to increase weight gain and fluid retension in few patients.
In patients with excessive weight gain and fluid retention this drug should be omitted first.

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Quiz : 33
● Which one of the following doesn't reflect the
goal of management of DM
A) To treat according to symptoms
B) Treat to targets
C) To reverse pathophysiology of DM
D) Prevent CAD
Goal of management of DM includes good glycemic control, management of
hypertension, dyslipedemia and other CV risk factor with aim to reduce micro and
macrovascular complications.
Defined targets of treatments must be attained while treating.
Diabetes and its complication often are asymptomatic, so management of DM
is NOT entirely based on symptoms of patient.

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Quiz : 34
● In which of these conditions Insulin therapy is
NOT a must?
A) Diabetic women desiring Pregnancy
B) Acute stressful situations like surgery and severe
infections
C) New onset Type 2 DM with FBS 186 and PP 296
D) GDM
Treatment with Insulin is must in Type 1 DM
It is also must in Diabetic women contemplating pregnancy, GDM, and acute stressful
Situations like infections, DKA, HONK etc.

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Quiz : 35
● Diabetic amyotrophy stands for:
A) Proximal myopathy seen in DM
B) Neuropathy involving lumbar roots and femoral nerve
C) Muscular dystrophy due to uncontrolled DM
D) None of the above
Diabetic amyotrophy stands for neuropathy involving lumbar nerve roots , lumbar plexus
and femoral nerve.
It is a Misnomer.
It usally starts unilaterally and then progress to toher side and is associated with pain in
both thighs and proximal muscle weakness.
Spontaneous recovery or improvement may occur over 6 – 18 months.

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Quiz : 36
● According to ADA , DM with known MI, which
drug is indicated to reduce CV risk?
A) ACE inhibitor, Statin, Aspirin
B) ACE inhibitor, Statin, Aspirin, Amlodepin
C) ACE inhibitor, Statin, Aspirin, B- Blocker
D) ACE inhibitor, Aspirin
As per ADA guideline to reduce risk of CV events in DM with MI, should recieve ACEi,
Statin, Aspirin, B – Blocker.
B – blocker should be continued for atleast 2 yrs after ACS, however long term use is
Also justified.

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Quiz : 37
● Which statin does NOT require dose
modification in Renal Failure?
A) Atorvastatin
B) Rosuvastatin
C) Pravastatin
D) Simvastatin
In setting of RF, atorvastatin does not require dose modification.
Dose of all other Statins needs to be adjusted / reduced in individuals with low eGFR

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Quiz : 38
● Which statement is not true regarding IGT?
A) 25% of people with IGT progress to Type 2 DM within 5
yrs (5% / yr)
B) 25 % revert to normoglycemia
C) 50% remain as IGT
D) It is not possible to slow or prevent progression of IFG /
IGT to diabetes by Life style changes and / or
medications
IGT is stage in natural history of glucose metabolism which abnormal.
25 % of people with IGT progress to Type 2 DM with in 5 yrs ( 5 % / yr).
25 % revert to normoglycemia.
50 % remains as IGT.
Life Style Modification must be advised to prvent / delay the progression
of IGT to Type 2 DM

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Quiz : 39
● Which statement among the following is NOT
true?
A) Beta cell produce Insulin
B) Delta cell produce somatostatin
C) F (PP) cell is responsible for production of pancreatic
polypeptide.
D) Alpha cell produce : GLP 1
Pancreas is endocrine gland in our body,
It has various types of cells with varied secretory functions.
Alpha cell produce Glucagon, Beta cell produce Insulin, Delta cell produce somatostatin
And F cell produce pancreatic polypeptide.
GLP 1 are incretin hormones produce by L cells from gastrointestinal tract.