Diabetes: sulfonylurea-induced hypoglycaemia: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Diabetes: sulfonylurea-induced hypoglycaemia

Sample item

A 72-year-old man with chronic kidney disease on glibenclamide is found unconscious with a glucose of 32 mg/dL. He recovers after intravenous dextrose but has repeated hypoglycaemia over the next 12 hours despite dextrose infusions. Which additional treatment is most appropriate?

ARepeated intravenous glucagon bolusesBSubcutaneous or intravenous octreotideCIntravenous hydrocortisoneDHaemodialysis to clear glibenclamide

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Subcutaneous or intravenous octreotide

Sulfonylureas stimulate insulin release through the pancreatic K-ATP channel, and renal impairment prolongs the effect, so hypoglycaemia recurs while dextrose itself provokes more insulin secretion. Octreotide inhibits beta-cell insulin secretion and is the recommended adjunct. Glucagon has a short effect and also stimulates insulin release, while the drug is highly protein bound and not dialysable.

Option by option

A. Repeated intravenous glucagon boluses
Glucagon acts briefly, depends on glycogen stores, and also stimulates insulin secretion, so it is less effective.
B. Subcutaneous or intravenous octreotide (correct)
Octreotide suppresses the insulin release that dextrose provokes in a sulfonylurea-exposed pancreas.
C. Intravenous hydrocortisone
Hydrocortisone is useful in adrenal insufficiency and has no role in drug-induced hyperinsulinaemia.
D. Haemodialysis to clear glibenclamide
Glibenclamide is highly protein bound, so dialysis removes little drug.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Subcutaneous or intravenous octreotide. Sulfonylureas stimulate insulin release through the pancreatic K-ATP channel, and renal impairment prolongs the effect, so hypoglycaemia recurs while dextrose itself provokes more insulin secretion.

Why is "Repeated intravenous glucagon boluses" not the answer?

Glucagon acts briefly, depends on glycogen stores, and also stimulates insulin secretion, so it is less effective.

Why is "Intravenous hydrocortisone" not the answer?

Hydrocortisone is useful in adrenal insufficiency and has no role in drug-induced hyperinsulinaemia.

Why is "Haemodialysis to clear glibenclamide" not the answer?

Glibenclamide is highly protein bound, so dialysis removes little drug.

What concept does this question test?

It tests Diabetes: sulfonylurea-induced hypoglycaemia in General Medicine. Octreotide inhibits beta-cell insulin secretion and is the recommended adjunct. Glucagon has a short effect and also stimulates insulin release, while the drug is highly protein bound and not dialysable.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Diabetes: sulfonylurea-induced hypoglycaemia?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.