Diabetes mellitus MCQs With Answer is a focused study resource tailored for B.Pharm students aiming to master the pharmacology, clinical management, and complications of diabetes. This concise, exam-oriented introduction covers key topics such as pathophysiology, diagnostic criteria, insulin types, oral antidiabetic drug classes, mechanisms of action, adverse effects, drug interactions, monitoring parameters, and acute emergencies like DKA and HHS. Each question emphasizes clinical relevance, dosing considerations, and patient counseling to build practical pharmacy competence. Use these MCQs to reinforce your understanding, improve recall, and prepare for university exams and clinical rotations. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which of the following fasting plasma glucose values is diagnostic for diabetes mellitus?
- ≥126 mg/dL (7.0 mmol/L)
- ≥110 mg/dL (6.1 mmol/L)
- ≥100 mg/dL (5.6 mmol/L)
- ≥140 mg/dL (7.8 mmol/L)
Correct Answer: ≥126 mg/dL (7.0 mmol/L)
Q2. Which test reflects average glycaemic control over the previous 2–3 months?
- Fasting plasma glucose
- Random blood glucose
- HbA1c
- Fructosamine
Correct Answer: HbA1c
Q3. Which of the following is a first-line oral agent for type 2 diabetes and reduces hepatic gluconeogenesis?
- Glimepiride
- Metformin
- Pioglitazone
- Acarbose
Correct Answer: Metformin
Q4. Metformin’s most common serious adverse effect that requires monitoring of renal function is:
- Hypoglycemia
- Lactic acidosis
- Hepatotoxicity
- Pancreatitis
Correct Answer: Lactic acidosis
Q5. Which oral antidiabetic class stimulates pancreatic insulin secretion by closing ATP-sensitive K+ channels?
- Biguanides
- Sulfonylureas
- Thiazolidinediones
- SGLT2 inhibitors
Correct Answer: Sulfonylureas
Q6. A patient on sulfonylurea therapy experiences severe hypoglycemia; the recommended immediate treatment for an unconscious patient is:
- Oral glucose gel
- Intravenous dextrose
- Subcutaneous insulin
- Oral sucrose tablets
Correct Answer: Intravenous dextrose
Q7. Which insulin preparation is considered rapid-acting?
- Insulin glargine
- Insulin detemir
- Insulin lispro
- NPH insulin
Correct Answer: Insulin lispro
Q8. Which long-acting insulin provides a relatively peakless basal profile?
- Regular human insulin
- NPH insulin
- Insulin glargine
- Insulin lispro
Correct Answer: Insulin glargine
Q9. The primary mechanism of action of SGLT2 inhibitors in the kidney is:
- Increase insulin secretion from beta cells
- Decrease hepatic glucose production
- Reduce renal glucose reabsorption in the proximal tubule
- Slow carbohydrate absorption in the gut
Correct Answer: Reduce renal glucose reabsorption in the proximal tubule
Q10. Which antidiabetic drug class is associated with increased risk of urinary tract infections and genital mycotic infections?
- DPP-4 inhibitors
- SGLT2 inhibitors
- Thiazolidinediones
- Meglitinides
Correct Answer: SGLT2 inhibitors
Q11. Pioglitazone acts primarily by activating which receptor?
- PPAR-alpha
- PPAR-gamma
- GLP-1 receptor
- DPP-4 enzyme
Correct Answer: PPAR-gamma
Q12. Which drug class delays absorption of carbohydrates from the intestine by inhibiting alpha-glucosidase?
- Alpha-glucosidase inhibitors (acarbose)
- Biguanides (metformin)
- Sulfonylureas
- DPP-4 inhibitors
Correct Answer: Alpha-glucosidase inhibitors (acarbose)
Q13. Which incretin-based therapy enhances GLP-1 activity by inhibiting its degradation?
- GLP-1 receptor agonists
- DPP-4 inhibitors
- SGLT2 inhibitors
- Alpha-glucosidase inhibitors
Correct Answer: DPP-4 inhibitors
Q14. Which glucose-lowering drug is associated with weight loss and has beneficial cardiovascular outcomes in some trials?
- Metformin
- Insulin detemir
- GLP-1 receptor agonists (e.g., liraglutide)
- Sulfonylureas
Correct Answer: GLP-1 receptor agonists (e.g., liraglutide)
Q15. The classic triad of symptoms in hyperglycemia includes:
- Weight gain, constipation, and cough
- Polyuria, polydipsia, polyphagia
- Bradycardia, hypotension, hypothermia
- Nausea, jaundice, pruritus
Correct Answer: Polyuria, polydipsia, polyphagia
Q16. Which complication is most directly assessed by annual urine albumin-to-creatinine ratio screening?
- Diabetic retinopathy
- Diabetic neuropathy
- Diabetic nephropathy
- Peripheral arterial disease
Correct Answer: Diabetic nephropathy
Q17. In diabetic ketoacidosis (DKA), the hallmark laboratory findings include:
- Hypoglycemia and metabolic alkalosis
- Hyperglycemia, ketonemia, metabolic acidosis
- Normal glucose and respiratory alkalosis
- Hypoglycemia and increased bicarbonate
Correct Answer: Hyperglycemia, ketonemia, metabolic acidosis
Q18. First-line intravenous fluid for initial resuscitation in DKA is:
- 0.9% normal saline
- 5% dextrose in water
- Half-normal saline (0.45% NaCl)
- Lactated Ringer’s only
Correct Answer: 0.9% normal saline
Q19. Which oral antidiabetic is contraindicated in patients with significant renal impairment due to accumulation risk?
- Metformin
- Pioglitazone
- Glimepiride
- Repaglinide
Correct Answer: Metformin
Q20. Which drug increases insulin sensitivity in peripheral tissues and can cause fluid retention and weight gain?
- Metformin
- Pioglitazone
- Sitagliptin
- Canagliflozin
Correct Answer: Pioglitazone
Q21. Rapid correction of hyperglycemia in DKA can precipitate which dangerous complication?
- Cerebral edema
- Hyperkalemia
- Renal failure
- Hepatic encephalopathy
Correct Answer: Cerebral edema
Q22. Which monitoring parameter is essential when a patient starts an SGLT2 inhibitor?
- Serum amylase
- Urine ketones regularly
- Renal function (eGFR)
- Thyroid function tests
Correct Answer: Renal function (eGFR)
Q23. Which antidiabetic medication class has a mechanism involving inhibition of hepatic gluconeogenesis and improved peripheral glucose uptake?
- Biguanides
- Meglitinides
- DPP-4 inhibitors
- Sulfonylureas
Correct Answer: Biguanides
Q24. Which insulin regimen is most appropriate for a hospitalized patient requiring tight control and frequent meals?
- Basal insulin only
- Sliding-scale insulin monotherapy
- Basal-bolus insulin regimen
- NPH at bedtime only
Correct Answer: Basal-bolus insulin regimen
Q25. Which oral antidiabetic should be taken with the first bite of a meal to reduce postprandial hyperglycemia?
- Acarbose
- Metformin
- Pioglitazone
- Sitagliptin
Correct Answer: Acarbose
Q26. Which DPP-4 inhibitor is commonly used as an oral agent with low hypoglycemia risk?
- Glipizide
- Sitagliptin
- Glibenclamide
- Repaglinide
Correct Answer: Sitagliptin
Q27. Which antidiabetic drug class is associated with increased risk of bone fractures and potential bladder cancer signals with some agents?
- Thiazolidinediones
- Biguanides
- Sulfonylureas
- SGLT2 inhibitors
Correct Answer: Thiazolidinediones
Q28. For a type 1 diabetic patient, the absence of which hormone confirms autoimmune β-cell destruction?
- Glucagon
- Insulin
- Somatostatin
- Amylin
Correct Answer: Insulin
Q29. Which of the following is most effective for acute severe hypoglycemia when IV access is not available?
- Oral glucose tablets
- Intramuscular glucagon
- Subcutaneous insulin
- Oral sucrose drink
Correct Answer: Intramuscular glucagon
Q30. Which lipid-lowering therapy is recommended as part of cardiovascular risk reduction in most diabetic patients?
- Fibrates
- Bile acid sequestrants
- Statins
- Omega-3 fatty acids only
Correct Answer: Statins
Q31. Which class of drugs can cause hypoglycemia when combined with insulin or sulfonylureas?
- SGLT2 inhibitors
- DPP-4 inhibitors
- Meglitinides
- Thiazolidinediones
Correct Answer: Meglitinides
Q32. In pregnancy, which antidiabetic drug is considered first-line for gestational diabetes management?
- Metformin
- Glyburide (glibenclamide)
- Insulin
- Pioglitazone
Correct Answer: Insulin
Q33. Which complication is screened by annual dilated retinal examination in diabetics?
- Diabetic neuropathy
- Diabetic retinopathy
- Nephrolithiasis
- Osteoporosis
Correct Answer: Diabetic retinopathy
Q34. Which oral agent acts by increasing incretin hormones through GLP-1 receptor agonism and is administered by injection?
- Sitagliptin
- Exenatide
- Metformin
- Pioglitazone
Correct Answer: Exenatide
Q35. The Somogyi effect refers to:
- Nocturnal hypoglycemia followed by morning hyperglycemia due to counter-regulatory hormones
- Early morning hyperglycemia due to dawn hormone surge only
- Persistent hypoglycemia despite reducing insulin
- Postprandial hyperglycemia without fasting changes
Correct Answer: Nocturnal hypoglycemia followed by morning hyperglycemia due to counter-regulatory hormones
Q36. Which electrolyte shift commonly occurs when insulin therapy is started in hyperglycemic patients?
- Serum potassium decreases as potassium shifts intracellularly
- Serum sodium dramatically increases
- Serum calcium decreases significantly
- Serum phosphate is unaffected
Correct Answer: Serum potassium decreases as potassium shifts intracellularly
Q37. Which class of antidiabetic agents requires dose adjustment or avoidance in severe renal impairment due to active metabolites?
- Sulfonylureas (e.g., glyburide)
- Thiazolidinediones (e.g., pioglitazone)
- GLP-1 receptor agonists
- Alpha-glucosidase inhibitors
Correct Answer: Sulfonylureas (e.g., glyburide)
Q38. Which biomarker increases risk stratification for cardiovascular disease in diabetic patients and is targeted by therapy with ACE inhibitors?
- Microalbuminuria
- Serum bilirubin
- Serum CPK
- Urine ketones
Correct Answer: Microalbuminuria
Q39. Which antidiabetic medication is associated with pancreatitis risk in some case reports?
- Metformin
- GLP-1 receptor agonists and DPP-4 inhibitors
- Alpha-glucosidase inhibitors
- SGLT2 inhibitors
Correct Answer: GLP-1 receptor agonists and DPP-4 inhibitors
Q40. For hospitalized patients on insulin, which practice is discouraged due to inadequate glucose control?
- Basal-bolus regimen
- Regular glucose monitoring
- Sliding-scale insulin monotherapy
- Adjusting doses based on nutrition and illness
Correct Answer: Sliding-scale insulin monotherapy
Q41. Hypoglycemia unawareness is most likely in patients with:
- Long-standing diabetes with frequent hypoglycemia
- New-onset type 2 diabetes
- Excellent glycemic control without hypoglycemia
- Only diet-controlled diabetes
Correct Answer: Long-standing diabetes with frequent hypoglycemia
Q42. Which oral antidiabetic drug works rapidly and is useful for controlling postprandial glucose when taken before meals?
- Repaglinide
- Metformin
- Pioglitazone
- Sitagliptin
Correct Answer: Repaglinide
Q43. Which adverse effect is a common concern with insulin therapy that may be mitigated by rotation of injection sites?
- Hypokalemia
- Lipodystrophy (lipoatrophy or lipohypertrophy)
- Renal toxicity
- Thrombocytopenia
Correct Answer: Lipodystrophy (lipoatrophy or lipohypertrophy)
Q44. The target HbA1c for most nonpregnant adults with diabetes as recommended by many guidelines is approximately:
- <7% (around 6.5–7.0%)
- 9–10%
- Less than 5%
- Around 8.5%
Correct Answer: <7% (around 6.5–7.0%)
Q45. Which medication reduces glucagon secretion and slows gastric emptying, contributing to reduced postprandial glucose?
- GLP-1 receptor agonists
- SGLT2 inhibitors
- Thiazolidinediones
- Alpha-glucosidase inhibitors
Correct Answer: GLP-1 receptor agonists
Q46. Which condition is a contraindication for metformin use?
- Stable mild chronic kidney disease (eGFR >60 mL/min/1.73 m2)
- Acute or chronic metabolic acidosis, including lactic acidosis
- Controlled hypertension
- Well-managed hyperlipidemia
Correct Answer: Acute or chronic metabolic acidosis, including lactic acidosis
Q47. In the context of diabetes, ACE inhibitors are prescribed primarily to:
- Improve glycemic control directly
- Reduce progression of diabetic nephropathy and lower blood pressure
- Promote insulin secretion
- Increase weight gain to improve nutrition
Correct Answer: Reduce progression of diabetic nephropathy and lower blood pressure
Q48. Which is a major microvascular complication of diabetes?
- Ischemic stroke
- Coronary artery disease
- Diabetic retinopathy
- Peripheral arterial disease
Correct Answer: Diabetic retinopathy
Q49. When counseling a patient starting insulin, which instruction is essential regarding storage?
- Keep unopened insulin at room temperature indefinitely
- Store opened insulin vials at room temperature for a limited period as per manufacturer guidelines
- Freeze insulin to prolong shelf life
- Expose insulin to direct sunlight occasionally to sterilize
Correct Answer: Store opened insulin vials at room temperature for a limited period as per manufacturer guidelines
Q50. Which parameter should pharmacists advise diabetic patients to monitor at home for daily self-management?
- Random liver enzymes
- Home blood glucose monitoring (capillary glucose)
- 24-hour urine protein daily
- Daily HbA1c measurements
Correct Answer: Home blood glucose monitoring (capillary glucose)
