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Here is a comprehensive set of high-yield NEET PG questions on Diabetes Mellitus with answers and explanations:
🩺 Diabetes Mellitus — NEET PG High-Yield Q&A
📋 SECTION 1: Diagnosis & Classification
Q1. What is the diagnostic criterion for Diabetes Mellitus using fasting plasma glucose?
Answer: ≥ 126 mg/dL (after ≥8 hours of overnight fast)
Other diagnostic criteria (any ONE of the following, confirmed on 2 occasions):
Criterion Cutoff Fasting Plasma Glucose (FPG) ≥ 126 mg/dL 2-hr Post 75g OGTT ≥ 200 mg/dL Random plasma glucose + symptoms ≥ 200 mg/dL HbA1c ≥ 6.5% ⚠️ Exception: If symptoms of hyperglycemia are present + random glucose ≥200, a single test is sufficient. (Developing a DM Comprehensive Care Plan 2022, p.4)
Q2. What are the prediabetes cutoffs?
| Parameter | Prediabetes Range |
|---|---|
| Fasting Plasma Glucose (IFG) | 100–125 mg/dL |
| 2-hr OGTT (IGT) | 140–199 mg/dL |
| HbA1c | 5.7%–6.4% |
🔑 Mnemonic: "1-1-2 for IFG" → 100–125 mg/dL
Q3. Autoantibodies positive in Type 1 Diabetes?
Answer: Type 1 DM is characterized by autoimmune destruction of β-cells. Antibodies include:
- Anti-GAD65 (glutamic acid decarboxylase) — most common
- Anti-IA-2 (tyrosine phosphatase)
- Anti-IA-2β (ZnT8)
- Anti-insulin antibodies
(DM Care Plan 2022, p.4)
Q4. Gestational Diabetes Mellitus (GDM) — When to screen?
Answer: 24–28 weeks of gestation for all pregnant women.
One-step approach (75g OGTT):
Time Cutoff Fasting ≥ 92 mg/dL 1-hour ≥ 180 mg/dL 2-hour ≥ 153 mg/dL Diagnosis: ANY ONE value meeting the threshold.
Two-step approach:
- Step 1: 50g glucose challenge (non-fasting), threshold ≥130 or ≥140 mg/dL at 1 hr
- Step 2 (if positive): 100g 3-hr OGTT — 2 or more values must be met:
- FPG ≥95, 1hr ≥180, 2hr ≥155, 3hr ≥140 mg/dL
💊 SECTION 2: Management
Q5. First-line drug for Type 2 DM?
Answer: Metformin (unless contraindicated)
- Mechanism: Decreases hepatic glucose production (inhibits gluconeogenesis), improves insulin sensitivity
- Contraindications: eGFR <30, IV contrast use, hepatic failure
- Does NOT cause hypoglycemia, causes lactic acidosis (rare)
- Weight neutral/weight loss
Q6. Which oral hypoglycemic agents cause hypoglycemia?
| Drug Class | Hypoglycemia Risk |
|---|---|
| Sulfonylureas (glibenclamide, glipizide) | ✅ Yes |
| Meglitinides (repaglinide) | ✅ Yes |
| Metformin | ❌ No |
| SGLT-2 inhibitors | ❌ No |
| GLP-1 agonists | ❌ No (monotherapy) |
| DPP-4 inhibitors | ❌ No |
| Thiazolidinediones (TZDs) | ❌ No |
Q7. Drug of choice in Type 2 DM with:
| Condition | Preferred Drug |
|---|---|
| Heart failure / ASCVD | SGLT-2 inhibitors (empagliflozin, dapagliflozin) |
| CKD (proteinuria) | SGLT-2 inhibitors or GLP-1 agonists |
| Obesity | GLP-1 agonists (semaglutide, liraglutide) |
| Elderly (hypoglycemia risk) | DPP-4 inhibitors (sitagliptin) |
| Dyslipidemia | Pioglitazone |
Q8. HbA1c target in most adults with T2DM?
Answer: < 7%
Relaxed to <8% in elderly patients with comorbidities, limited life expectancy, or hypoglycemia-prone individuals.
⚡ SECTION 3: Complications
Q9. Most common cause of death in Type 2 DM?
Answer: Cardiovascular disease (Coronary artery disease)
Q10. Diabetic nephropathy — earliest marker?
Answer: Microalbuminuria (albumin excretion 30–300 mg/day or ACR 30–300 mg/g)
- First functional change: Glomerular hyperfiltration (↑ GFR)
- First morphological change: Glomerular basement membrane thickening
- Pathognomonic lesion: Kimmelstiel-Wilson nodules (nodular glomerulosclerosis)
Q11. Most common cause of blindness in diabetics?
Answer: Diabetic retinopathy
- Earliest sign: Microaneurysms
- Pre-proliferative: Cotton wool spots, hard exudates, venous beading
- Proliferative: Neovascularization — treated with laser photocoagulation
- Macular edema: Most common cause of visual loss (not blindness) in diabetics
Q12. Charcot's joint (neuropathic arthropathy) in diabetes — which joint most commonly affected?
Answer: Tarsometatarsal joint (foot)
Q13. Diabetic ketoacidosis (DKA) — precipitating cause?
Answer: Infection (most common) → especially pneumonia, UTI
DKA triad: Hyperglycemia + Metabolic acidosis + Ketonemia
- Blood glucose typically >250 mg/dL
- pH <7.3, Bicarbonate <18 mEq/L
- Anion gap metabolic acidosis (ketones = acetoacetate + β-hydroxybutyrate)
- Treatment: IV fluids → Insulin → Potassium correction
Q14. Hyperosmolar Hyperglycemic State (HHS) vs DKA?
| Feature | DKA | HHS |
|---|---|---|
| Type of DM | Type 1 | Type 2 |
| Blood glucose | >250 mg/dL | >600 mg/dL |
| Ketones | +++ | Absent/minimal |
| pH | <7.3 | >7.3 |
| Mortality | ~5% | ~15–20% |
| Osmolality | Mildly elevated | >320 mOsm/kg |
🔬 SECTION 4: One-Liners for NEET PG
| Fact | Answer |
|---|---|
| "Double diabetes" | T1DM + insulin resistance features |
| Somogyi effect | Rebound hyperglycemia after nocturnal hypoglycemia |
| Dawn phenomenon | Morning hyperglycemia due to GH/cortisol surge (no nocturnal hypoglycemia) |
| Best marker of long-term glycemic control | HbA1c |
| HbA1c reflects last | 3 months (mainly last 6–8 weeks) |
| Drug causing hyperglycemia | Thiazides, steroids, tacrolimus |
| MODY inheritance | Autosomal dominant |
| Most common MODY type | MODY 2 (glucokinase mutation) in Europe; MODY 3 (HNF-1α) overall |
| Neonatal DM if < | 6 months of age |
| C-peptide low in | T1DM (absolute insulin deficiency) |
| C-peptide normal/high in | T2DM, factitious hypoglycemia (exogenous insulin) |
🎯 Rapid-Fire Pattern Questions
Q: A 45-year-old obese woman with T2DM has eGFR 25 ml/min. Which drug is contraindicated?
A: Metformin (contraindicated if eGFR <30)
Q: A diabetic patient on insulin develops hypoglycemia at 3 AM but high glucose at 7 AM. Diagnosis?
A: Somogyi effect — reduce evening insulin dose
Q: Which insulin has NO peak and provides 24-hour coverage?
A: Insulin glargine (Lantus) — basal insulin
Q: Triopathy of diabetes?
A: Retinopathy + Nephropathy + Neuropathy
Want me to go deeper into any specific topic — like insulin types, DKA management protocol, diabetic retinopathy staging, or MODY genetics? Just ask!
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Which one do you want first?
- Insulin types and regimens (ultra-short, short, intermediate, long-acting, premix, basal-bolus)
- DKA management protocol (step-by-step fluids, insulin, potassium, bicarbonate)
- Diabetic retinopathy staging and treatment
- MODY and other diabetes genetics
- NEET PG MCQ practice set on diabetes (with explanations)
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