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In-time, Insulin Intervention: the right insulin, the right patient – Case study 1

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In-time, Insulin Intervention – the right insulin, the right patient – Case study 1
In-time, Insulin Intervention: the right insulin, the right patient – Case study 1

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Question 1 of 10

1. Question

1. What clinical and test result findings does Mrs KM have that suggest possible target organ damage?

A. Peripheral neuropathy symptoms
Correct Incorrect Correct answer

B. Microalbuminuria
Correct Incorrect Correct answer

C. Metabolic dysfunction-associated liver disease (MASLD)
Correct Incorrect Correct answer

D. All of the above
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Question 2 of 10

2. Question

2. What is the most urgent therapeutic priority?

A. Optimise statin therapy
Correct Incorrect Correct answer

B. Treat microalbuminuria
Correct Incorrect Correct answer

C. Achieve rapid glycaemic control
Correct Incorrect Correct answer

D. Investigate transaminitis first
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Question 3 of 10

3. Question

3. What best explains deterioration despite metformin, sulphonylurea and GLP-1 RA (assuming patient is compliant with diet/exercise)?

A. Medication non-adherence
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B. Progressive β-cell failure
Correct Incorrect Correct answer

C. Acute infection
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D. Drug interaction
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Question 4 of 10

4. Question

4. In this patient, acute glaucoma is the most likely aetiology of her blurred vision.

A. True
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B. False
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Question 5 of 10

5. Question

5. What cardiometabolic risks must be addressed concurrently?

A. Atherosclerotic cardiovascular disease (ASCVD) risk
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B. Early diabetic kidney disease
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C. MASLD
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D. All of the above
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Question 6 of 10

6. Question

6. What is the most appropriate intensification strategy for this patient’s diabetic control?

A. Add DPP-4 inhibitor
Correct Incorrect Correct answer

B. Increase sulphonylurea further
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C. Initiate second-generation basal insulin (glargine 300 units/ml or degludec)
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D. Immediately start full basal-bolus regimen
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Question 7 of 10

7. Question

7. What is the recommended starting dose for basal insulin in this patient?

A. Fixed 40 units daily
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B. 0.2-0.3 units/kg/day
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C. 1 unit/kg/day
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D. Fixed-dose 20 units daily
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Question 8 of 10

8. Question

8. In this patient that has a persistently elevated ALT (90 IU/l) and AST (71 IU/l) in the context of T2DM and metabolic risk factors, what is the most appropriate next step in evaluating suspected MASLD?

A. Arrange immediate liver biopsy
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B. Calculate a non-invasive liver fibrosis score (e.g. FIB-4)
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C. Start corticosteroid therapy
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D. No further evaluation is required.
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Question 9 of 10

9. Question

9. How should her cardiovascular risk be classified (according to the 2025 focused update of the 2019 ESC/EASD guidelines for the management of dyslipidaemias) and what LDL target should be pursued?

A. Moderate risk; LDL target <2.5mmol/l
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B. High risk; LDL target <1.8mmol/l
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C. Very high risk; LDL target <1.4mmol/l
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D. No specific LDL target required
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Question 10 of 10

10. Question

10. Based on the CGM data, what is the most appropriate next step in glycaemic management?

A. Maintain current insulin dose
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B. Reduce basal insulin
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C. Further titrate basal insulin upward
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D. Initiate immediate prandial insulin
Correct Incorrect Correct answer

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