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Type 1 diabetes with impaired hypoglycaemia awareness — SCE Endocrinology MCQ

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ModerateDiabetes mellitusType 1 diabetes with impaired hypoglycaemia awarenessSCE Endocrinology

A 31-year-old woman with type 1 diabetes uses multiple daily injections and is troubled by nocturnal hypoglycaemia despite education and dose review. She has impaired awareness of hypoglycaemia and drives for work. HbA1c is 61 mmol/mol. What is the most appropriate management?

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Correct answer: C — Offer real-time continuous glucose monitoring with structured specialist review

Offer real-time continuous glucose monitoring with structured specialist review is best because recurrent hypoglycaemia with impaired awareness is a strong indication for continuous glucose monitoring and specialist optimisation. The alternatives are less appropriate because increasing basal insulin worsens the trigger; premixed insulin reduces flexibility; fixed doses undermine modern type 1 management; sulfonylureas are inappropriate in type 1 diabetes. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG17