Diabetes Mellitus - Complications and Management MCQs

Ultra short acting Aspart Lispro Glulisine Short acting Regular insulin Intermediate acting NPH Lente Long acting Detemir Glargine Degludec Reference: Harrison's Principles of Internal Medicine 21 st edition page 3108

Up to 5% of patients taking chlorpropamide may develop inappropriate ADH-like syndrome resulting in dilutional hyponatremia. Drugs causing SIADH : ( 5C + SVOT ) C yclophosphamide C hlorpropamide C arbamazepine C hlorpromazine C lofibrate S SRI V incristine O xytocin T ricyclic antidepressants Reference : Harrison's Principles of Internal Medicine 21 st edition Page 2924

Campylobacter is a leading cause of diarrhoeal illness, often caused by ingestion of undercooked meat harboring the pathogen. It is also a major cause of traveller's diarrhea . The use of antibiotic therapy for the management of Campylobacter infection in adults is controversial. Antibiotic of choice in this infection is erythromycin, though ciprofloxacin and tetracycline may also be appropriate. However, appropriate fluid replacement and anti-emetics are initially indicated - most units advocate no antibiotic treatment. Antibiotics are not recommended in patients with nontyphoid Salmonella, Campylobacter, STEC, Aeromonas, or Yersinia, except in severe disease, because they do not hasten recovery or reduce the period of fecal bacterial excretion Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 133, Pg: 1065

Both insulin glargine and insulin detemir are long-acting insulin analogues, which have been primarily shown in Type 1 diabetes to reduce nocturnal hypoglycaemia. Traditional long-acting insulin, novomix 50/50 is unlikely to be of much help in this patient as it would still necessitate a BD dosing regime. Insulin lispro was the first insulin analogue to be developed, by reversing the position of two amino-acids (lysine and praline) in the B-chain of human insulin. This allows larger amounts of prandial insulin to be available soon after injection and reduces the chance of between meal hypoglycemia. Reference: Harrison’s Principles of Internal Medicine 20 th edition Ch: 397,399 Pg:2863-64,2885-88

There are reports of increased incidence of DKA with the use of SGLT2 inhibitors Hence SGLT2 inhibitor are not advocated for use during acute infections and perioperative period The mechanisms of increased risk of DKA include: Diuretic effect producing volume contraction Hyperglucagonemia Non-insulin dependent glucose reduction In many occasions, DKA precipitated by SGLT2 inhibitors occur at blood glucose levels lower than usual (Euglycemic DKA) Reference: Harrison's Principles of Internal Medicine 21 st edition page 3110

Tirzepatide is the dual GLP1 and GIP agonist (SURPASS clinical trial) Teduglutide is the GLP2 inhibitor used in short bowel syndrome Imeglimin is the oxidative phosphorylation inhibitor used in Diabetes Dorzagliatin is the glucokinase activator for the management of DM Reference: SURPASS Trial - NEJM 2021

Pioglitazone like other PPAR gamma agonists such as rosiglitazone may cause fluid retention (about 10%) and this can be minimized by avoiding agents that may exacerbate fluid retention such as calcium antagonists. Due to this effect, it is contraindicated in patients with advanced heart failure and also in severe diabetic retinopathy where it may precipitate macular edema. Other notable side effects include reduction of bone density, reduction of haematocrit due to hemodilution and a doubtful increase in risk of bladder cancer. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 1936

Lesions beyond the optic chiasma produces homonymous hemianopia. Hence optic chiasm and optic nerve are ruled out. Optic chiasmal lesions cause bitemporal hemianopia and optic nerve lesions cause complete blindness in the affected eye. Involvement of the optic radiation that loop inferiorly into the temporal lobe, called the Meyer’s loop, cause superior quadrantanopia which will be homonymous. Lesions of the occipital cortex causes homonymous hemianopia. Optic radiation that loops superiorly into the parietal lobe causes inferior qudrantanopia. Hence among the given options the one that unequivocally causes a quadantanopia superiorly on the right side is a temporal lobe lesion on the left side Reference: Harrison’s Principles of Internal Medicine 21st h edition Chapter:32, page number:219