Diabetes Mellitus Overview Practice Questions

25 multiple-choice questions on Diabetes mellitus overview for paramedic and EMT students, from Chapter 24 (Endocrine Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A type 1 diabetic has the flu and is eating very little. Regarding her insulin, she should usually:

   1. A. Hold insulin until she can eat
   2. B. Keep taking it; check glucose often
   3. C. Take half her usual dose
   4. D. Switch to oral diabetes pills for now
   Show answer

   Answer: B. Keep taking it; check glucose often

   Illness raises stress hormones and glucose, and type 1 patients always need basal insulin to prevent DKA, even when not eating. Sick-day rules call for frequent glucose and ketone checks and fluids.

2. A dark, velvety skin thickening on the back of the neck and in the armpits suggests:

   1. A. Liver failure
   2. B. Vitamin C deficiency
   3. C. Insulin resistance
   4. D. A fungal infection
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   Answer: C. Insulin resistance

   Acanthosis nigricans is a marker of insulin resistance and is common in people with obesity, prediabetes, and type 2 diabetes. It is not dirt or infection.

3. Which patient is most likely to develop diabetic ketoacidosis rather than HHS?

   1. A. An 80-year-old with type 2
   2. B. A 60-year-old on metformin
   3. C. A 70-year-old on diet control
   4. D. A 14-year-old with type 1
   Show answer

   Answer: D. A 14-year-old with type 1

   Type 1 patients have almost no insulin, so fat breakdown and ketone production are unchecked. Type 2 patients usually have enough insulin to block ketosis, so they develop HHS.

4. The classic 'three P's' of uncontrolled diabetes are:

   1. A. Pallor, pain, and paralysis
   2. B. Pulse, pressure, perfusion
   3. C. Pruritus, pyrexia, and palpitations
   4. D. Polyuria, polydipsia, polyphagia
   Show answer

   Answer: D. Polyuria, polydipsia, polyphagia

   High glucose spills into urine, pulling water with it (polyuria), causing thirst (polydipsia). Cells starve, causing hunger (polyphagia).

5. Why does high blood glucose cause frequent urination?

   1. A. Glucose in the urine pulls water
   2. B. Insulin stimulates the bladder muscle
   3. C. Ketones irritate the bladder
   4. D. The kidneys stop filtering
   Show answer

   Answer: A. Glucose in the urine pulls water

   When glucose exceeds the kidney's ability to reabsorb it (about 180 mg/dL), it stays in the urine and drags water with it. This is osmotic diuresis.

6. An adult has a fasting glucose of 112 mg/dL on two occasions. This is classified as:

   1. A. Normal glucose
   2. B. Prediabetes
   3. C. Type 1 diabetes
   4. D. Hypoglycemia
   Show answer

   Answer: B. Prediabetes

   A fasting glucose of 100 to 125 mg/dL indicates prediabetes (impaired fasting glucose); 126 mg/dL or higher on two tests diagnoses diabetes.

7. Hemoglobin A1C reflects average blood glucose over about:

   1. A. The past 24 hours
   2. B. The past week
   3. C. 2 to 3 months
   4. D. The past 2 years
   Show answer

   Answer: C. 2 to 3 months

   Glucose binds to red cell hemoglobin over the cell's life span, so A1C shows long-term control. A single fingerstick shows only the moment.

8. Gestational diabetes is diabetes that:

   1. A. Starts in early childhood
   2. B. Develops during pregnancy
   3. C. Follows pancreatitis
   4. D. Is caused by steroids
   Show answer

   Answer: B. Develops during pregnancy

   Pregnancy hormones increase insulin resistance. It usually resolves after delivery but raises the risk of later type 2 diabetes.

9. A patient taking semaglutide has severe, constant upper abdominal pain that bores into the back, with vomiting. You should consider:

   1. A. Acute pancreatitis
   2. B. A normal side effect only
   3. C. Low blood sugar
   4. D. An allergic rash
   Show answer

   Answer: A. Acute pancreatitis

   GLP-1 receptor agonists such as semaglutide carry warnings for acute pancreatitis and gallbladder disease. Nausea is a common side effect, but severe boring pain needs evaluation.

10. A patient who takes a weekly GLP-1 drug such as semaglutide needs sedation. Why is this relevant?

    1. A. It raises the risk of low blood sugar
    2. B. It prolongs the sedative's effect
    3. C. It lowers the BP sharply
    4. D. The stomach may hold food longer
    Show answer

    Answer: D. The stomach may hold food longer

    GLP-1 agonists slow gastric emptying, so patients may have retained stomach contents and higher aspiration risk despite fasting. Anesthesia societies advise extra caution. GLP-1 drugs rarely cause low blood sugar on their own, and they do not prolong sedatives or cause sharp drops in blood pressure.

11. After an intentional overdose of long-acting insulin, hypoglycemia may last:

    1. A. About 30 minutes
    2. B. About 2 to 4 hours
    3. C. Many hours to days
    4. D. Only until the next meal
    Show answer

    Answer: C. Many hours to days

    Large subcutaneous depots of insulin are absorbed slowly, so hypoglycemia can recur for 24 hours or more and often needs continuous dextrose and admission. A single dose of dextrose is rarely enough. A window of minutes to a few hours fits rapid-acting insulin, not a long-acting overdose.

12. Rapid-acting insulin such as lispro begins working within about:

    1. A. 4 to 6 hours
    2. B. 12 hours
    3. C. 24 hours
    4. D. 15 minutes
    Show answer

    Answer: D. 15 minutes

    Rapid-acting insulin such as lispro starts working within about 15 minutes and is taken with meals; if the patient then does not eat, hypoglycemia can follow quickly. An onset of 4 to 6 hours is far too slow for any rapid-acting product. Twelve and 24 hours describe the duration of intermediate- and long-acting insulins, not the onset of rapid-acting insulin.

13. The rapid-acting insulin a patient takes with each meal is called:

    1. A. Bolus (mealtime) insulin
    2. B. Basal insulin
    3. C. Rescue glucagon
    4. D. Correction tablets by mouth
    Show answer

    Answer: A. Bolus (mealtime) insulin

    Insulin regimens combine basal insulin, which covers needs between meals and overnight, with bolus doses given at meals to cover carbohydrates. Glucagon raises glucose and is not insulin.

14. An insulin pump delivers insulin through:

    1. A. A port placed directly into a vein
    2. B. A small catheter under the skin
    3. C. A patch on the tongue
    4. D. An inhaler into the lungs
    Show answer

    Answer: B. A small catheter under the skin

    Pumps give a continuous basal rate of rapid-acting insulin through a subcutaneous cannula, plus boluses for meals.

15. Why can an insulin pump failure lead to DKA within hours?

    1. A. Pumps hold a week of long-acting insulin
    2. B. Pumps also deliver glucagon
    3. C. Pumps use only short-acting insulin
    4. D. The cannula releases ketones
    Show answer

    Answer: C. Pumps use only short-acting insulin

    With no long-acting insulin on board, a blocked or disconnected pump leaves the patient with almost no insulin, and ketones build quickly.

16. An automated (closed-loop) insulin delivery system adjusts insulin based on readings from:

    1. A. The patient's pulse oximeter
    2. B. A continuous glucose monitor
    3. C. A blood pressure cuff
    4. D. Daily urine ketone strips
    Show answer

    Answer: B. A continuous glucose monitor

    Hybrid closed-loop systems link a pump to a CGM and use an algorithm to raise or suspend basal insulin automatically. Errors in CGM readings or sensor failure can therefore affect dosing.

17. A continuous glucose monitor (CGM) measures glucose in:

    1. A. Interstitial fluid under the skin
    2. B. Capillary blood from the fingertip
    3. C. Venous blood under the skin
    4. D. Sweat on the skin surface
    Show answer

    Answer: A. Interstitial fluid under the skin

    CGMs lag behind blood glucose by several minutes. Confirm a critical reading with a fingerstick. The sensor filament sits in the fluid between cells, not in a vein, a capillary, or sweat.

18. Long-term diabetes damages small vessels, causing:

    1. A. Stroke, heart attack, and leg ischemia
    2. B. Gout, kidney stones, and gallstones
    3. C. Asthma, eczema, rhinitis
    4. D. Retinopathy, nephropathy, neuropathy
    Show answer

    Answer: D. Retinopathy, nephropathy, neuropathy

    Microvascular damage harms the eyes, kidneys, and nerves. Diabetes is a leading cause of blindness and kidney failure. Stroke, heart attack, and leg ischemia are large-vessel (macrovascular) complications.

19. Compared with a fingerstick, a continuous glucose monitor reading usually lags by about:

    1. A. 2 to 3 seconds
    2. B. 4 to 6 hours
    3. C. 5 to 15 minutes
    4. D. 1 full day or longer
    Show answer

    Answer: C. 5 to 15 minutes

    CGMs measure interstitial fluid glucose, which trails blood glucose by several minutes, so readings can be misleading when glucose is changing fast. Confirm with a fingerstick before treating.

20. A 17-year-old with type 1 diabetes has repeated DKA and weight loss, and admits skipping insulin to stay thin. You should consider:

    1. A. An eating disorder
    2. B. Normal teen behavior
    3. C. Insulin allergy
    4. D. Type 2 diabetes
    Show answer

    Answer: A. An eating disorder

    Deliberate insulin restriction for weight control (sometimes called diabulimia) is an eating disorder linked to recurrent DKA, complications, and high mortality. It needs mental health referral and nonjudgmental care.

21. Diabetic patients are at increased risk of infection because high glucose:

    1. A. Kills bacteria on contact in wounds
    2. B. Raises the fever response to infection
    3. C. Impairs white blood cell function
    4. D. Speeds healing of skin wounds
    Show answer

    Answer: C. Impairs white blood cell function

    Hyperglycemia weakens immune defenses and slows healing. Infection is a common trigger of DKA and HHS.

22. Which illness most commonly triggers DKA or HHS?

    1. A. A missed dose of a statin
    2. B. Mild dehydration after exercise
    3. C. A low-carbohydrate diet
    4. D. Infection
    Show answer

    Answer: D. Infection

    Infection raises stress hormones that raise glucose. Missed insulin, MI, stroke, and pancreatitis are other triggers.

23. Steroid medications such as prednisone tend to:

    1. A. Lower blood glucose
    2. B. Raise blood glucose
    3. C. Cure type 2 diabetes
    4. D. Stop ketone formation
    Show answer

    Answer: B. Raise blood glucose

    Corticosteroids increase glucose production and insulin resistance. Diabetics on steroids often need more insulin.

24. A diabetic patient has a foul-smelling, swollen, red foot ulcer with fever. This is concerning for:

    1. A. A normal, thickened foot callus
    2. B. Simple dry skin
    3. C. Spreading infection
    4. D. Healing tissue
    Show answer

    Answer: C. Spreading infection

    Diabetic foot infections can spread to bone and cause sepsis. Fever and redness need prompt evaluation.

25. Which statement about blood glucose meters is correct?

    1. A. They are accurate in shock
    2. B. They measure ketones too
    3. C. Readings never need to be repeated
    4. D. Very high values may read 'HI'
    Show answer

    Answer: D. Very high values may read 'HI'

    Meters have upper and lower limits and can be inaccurate with poor perfusion or contamination. Repeat questionable readings.