Type 2 Diabetes — SCE Endocrinology MCQ

Correct answer: A — Initiate insulin therapy

The correct answer is A, initiate insulin therapy. This patient has marked symptomatic hyperglycaemia (polyuria, polydipsia) with an HbA1c of 10.8% (roughly 95 mmol/mol) and a fasting glucose of 17.8 mmol/L, both well above the thresholds at which oral or injectable non-insulin agents are too slow to achieve safe control. NICE guidance on type 2 diabetes management advises that if an adult is symptomatically hyperglycaemic, insulin (or a sulfonylurea) should be considered as initial treatment, with review once control is achieved. Insulin acts independently of residual beta cell function or incretin pathways, giving rapid, reliable glucose lowering and reversing the catabolic state (weight loss, dehydration, glucotoxicity) driving the symptoms. Once symptoms settle and glucose falls, therapy can often be simplified or transitioned to oral agents.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions