1.Theme: Management of Diabetes Complications Options: A. Basal-bolus insulin regimen B. Insulin pump therapy C. Sliding scale insulin D. Oral metformin E. SGLT2 inhibitor (e.g., dapagliflozin) F. Sulfonylurea (e.g., gliclazide) G. GLP-1 receptor agonist H. Diabetic foot ulcer care referral I. Urgent ophthalmology referral J. Renal function monitoring K. Diabetic education program referral L. Diabetic ketoacidosis protocol Stems: 1. A 35-year-old woman with type 1 diabetes presents with nausea, vomiting, and abdominal pain. She is tachycardic, tachypnoeic, and has a fruity odour on her breath. Blood glucose is 28 mmol/L, and ketones are positive. 2. A 55-year-old man with a 15-year history of type 2 diabetes presents with a painless ulcer on the sole of his right foot. The area is surrounded by callus, and there is peripheral neuropathy on exam. 3. A 65-year-old woman with obesity and type 2 diabetes is poorly controlled on metformin. Her HbA1c is 9.5%. She has a BMI of 36 and is keen to lose weight. 4. A 50-year-old man with known diabetes presents with sudden, painless vision loss in one eye. Fundoscopy reveals retinal haemorrhages and macular oedema. 5. A 70-year-old man with long-standing type 2 diabetes is started on an SGLT2 inhibitor. His GP is concerned about possible adverse effects and wants to monitor appropriately. Instructions: For each patient described above, choose the most appropriate next step in management from the list of options. Answers and Explanations: 1 → L. Diabetic ketoacidosis protocol Classic presentation of DKA – urgent treatment required with fluids, insulin, and electrolyte correction. 2 → H. Diabetic foot ulcer care referral Neuropathic ulcer with risk of infection and amputation – refer to diabetic foot multidisciplinary team. 3 → G. GLP-1 receptor agonist GLP-1 agonists are effective in weight loss and HbA1c reduction, ideal for obese patients. 4 → I. Urgent ophthalmology referral Painless vision loss with retinal haemorrhages indicates proliferative diabetic retinopathy or macular oedema – urgent specialist input needed. 5 → J. Renal function monitoring SGLT2 inhibitors can cause volume depletion and affect kidney function; renal monitoring is important.
