Carbohydrate metabolism: SGLT2 inhibition: practice question

A Biochemistry 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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Biochemistry · Carbohydrate metabolism: SGLT2 inhibition

Sample item

A patient with type 2 diabetes is started on a new tablet. Soon afterwards he has glucose in his urine despite only modestly raised plasma glucose, and develops genital candidiasis. Which transporter is inhibited?

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

The answer and the reasoning

A. Sodium-glucose cotransporter 2 in the proximal tubule

SGLT2 in the early proximal tubule reabsorbs most filtered glucose. Gliflozins inhibit it, causing glucosuria and a fall in plasma glucose independent of insulin. The sugar-rich urine predisposes to genital mycotic infections.

Option by option

  • A. Sodium-glucose cotransporter 2 in the proximal tubule (correct)

    Correct. SGLT2 inhibition blocks renal glucose reabsorption, causing glycosuria and fungal infections.

  • B. Glucose transporter 2 in the beta cell

    GLUT2 in the beta cell senses glucose for insulin release, and its inhibition would not produce urinary glucose loss.

  • C. Sodium-glucose cotransporter 1 in the jejunum

    SGLT1 in the jejunum absorbs dietary glucose and galactose; inhibition would cause diarrhoea rather than glycosuria.

  • D. Glucose transporter 4 in skeletal muscle

    GLUT4 is the insulin-responsive transporter of muscle and fat, and blocking it would not cause glycosuria.

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.

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Questions about this Biochemistry question

What is the answer to this Biochemistry question?

The best answer is A, Sodium-glucose cotransporter 2 in the proximal tubule. SGLT2 in the early proximal tubule reabsorbs most filtered glucose.

Why is "Glucose transporter 2 in the beta cell" not the answer?

GLUT2 in the beta cell senses glucose for insulin release, and its inhibition would not produce urinary glucose loss.

Why is "Sodium-glucose cotransporter 1 in the jejunum" not the answer?

SGLT1 in the jejunum absorbs dietary glucose and galactose; inhibition would cause diarrhoea rather than glycosuria.

Why is "Glucose transporter 4 in skeletal muscle" not the answer?

GLUT4 is the insulin-responsive transporter of muscle and fat, and blocking it would not cause glycosuria.

What concept does this question test?

It tests Carbohydrate metabolism: SGLT2 inhibition in Biochemistry. Gliflozins inhibit it, causing glucosuria and a fall in plasma glucose independent of insulin. The sugar-rich urine predisposes to genital mycotic infections.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Carbohydrate metabolism: SGLT2 inhibition?

Build one table of enzyme deficiency, disease, inheritance and key finding, then revise it by spaced recall. Then use the flashcards and the other Biochemistry 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.