Hypoglycaemia Management — RACP Adult Medicine MCQ

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EasyEndocrinology & DiabetesHypoglycaemia ManagementRACP Adult Medicine

A 62-year-old man with type 2 diabetes on metformin, gliclazide, and basal insulin presents with recurrent early morning hypoglycaemia (BGLs 2.5–3.5 mmol/L). His HbA1c is 44 mmol/mol. What is the priority management change?

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Correct answer: E — Cease gliclazide

An HbA1c of 44 mmol/mol with recurrent hypoglycaemia indicates over-treatment. Sulfonylureas (gliclazide) are the most common cause of hypoglycaemia among oral agents and should be the first medication reduced or ceased, particularly in older patients. The insulin dose should also be reviewed, but sulfonylurea cessation is the priority as it addresses the drug-induced hypoglycaemia. The HbA1c target in an older patient with hypoglycaemia risk should be relaxed to 7–8%.

Reference: ADS – 2024 – Type 2 Diabetes Management; eTG – 2025 – Endocrinology