Endocrinology and diabetes: glucocorticoid-induced hyperglycaemia: 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 · Endocrinology and diabetes: glucocorticoid-induced hyperglycaemia

Sample item

A 60-year-old man with type 2 diabetes starts prednisolone 40 mg every morning. His fasting glucose is normal, but readings reach 300 mg/dL in the afternoon and evening. Which insulin strategy best matches this pattern?

ABedtime long-acting basal insulin aloneBIncreased bedtime metformin onlyCA maximal evening sulfonylurea doseDMorning intermediate-acting NPH insulin

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

The answer and the reasoning

D. Morning intermediate-acting NPH insulin

Morning prednisolone peaks in effect over the afternoon and evening, so it raises postprandial glucose while fasting values stay near normal. NPH given with the steroid dose has a matching peak. Basal bedtime insulin risks fasting hypoglycaemia.

Option by option

A. Bedtime long-acting basal insulin alone
Bedtime basal insulin targets fasting glucose, which is normal, and risks overnight hypoglycaemia.
B. Increased bedtime metformin only
Metformin at night would not control the daytime peak.
C. A maximal evening sulfonylurea dose
A late sulfonylurea increases hypoglycaemia risk overnight without covering the afternoon.
D. Morning intermediate-acting NPH insulin (correct)
Correct. NPH insulin with the morning steroid matches the afternoon peak of hyperglycaemia.

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 D, Morning intermediate-acting NPH insulin. Morning prednisolone peaks in effect over the afternoon and evening, so it raises postprandial glucose while fasting values stay near normal.

Why is "Bedtime long-acting basal insulin alone" not the answer?

Bedtime basal insulin targets fasting glucose, which is normal, and risks overnight hypoglycaemia.

Why is "Increased bedtime metformin only" not the answer?

Metformin at night would not control the daytime peak.

Why is "A maximal evening sulfonylurea dose" not the answer?

A late sulfonylurea increases hypoglycaemia risk overnight without covering the afternoon.

What concept does this question test?

It tests Endocrinology and diabetes: glucocorticoid-induced hyperglycaemia in General Medicine. NPH given with the steroid dose has a matching peak. Basal bedtime insulin risks fasting hypoglycaemia.

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 Endocrinology and diabetes: glucocorticoid-induced hyperglycaemia?

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.