Question

6. Diabetic Ketoacidosis can occur in a patient with severely uncontrolled diabetes. Which of the following is a key contributor to the acidosis?

a. uncontrolled gluconeogenesis during the absorptive and post-absorptive state

b. Increased liver glycogenesis during the absorptive state

c.Decreased ketone body production in the liver during the post-absorptive state

7. Which of the following statements regarding Type 1 diabetics is true?

a. Type 1 debiatics cannot produce insulin

b. Type 1 diabetics are typically treated with insulin sensitizers

c. Type 1 diabetics are insulin resistant

8. Identify the gluconeogenic pathway

a. Glycogen--- glucose

b. Fatty acid--- keto acid----glucose

c. Amino acid--- keto acid----- glucose

9. Which of the following would you expect to be associated with this presentation?

Patient- 21 year old male

Chief complaint- Abdominal pain, nausea and vomiting. increased thirst and frequency of urination

Background- Patient is a type 1-diabetic

Examination notes- Insulin pump appears to have stopped working, elevated plasma glucose levels following a finger prick.

a. Decreased serum ketones

b. increased Plasma pH

c. Increased protein glycation (AGEs) within the plasma

10. Which of the following events is most likely occurring during the postabsorptive state?

a. Glycogen is being hydrolyzed releasing individual glucose monomers into the blood

b. chylomicrons are circulating in the plasma

c. Gluconeogenesis is actively occurring in must cells within the body

Answer 1

6. Diabetic ketoacidosis is a complication of Diabetes Mellitus especially type I DM (insulin deficiency) in which a patient has elevated serum and urine concentration of ketone bodies. Insulin deficiency in diabetes Mellitus can cause insulin-glucagon imbalance (more glucagon). This glucagon stimulates the lipolysis in the fat and releases of long-chain fatty acids and glycerol. Fatty acid undergoes beta-oxidation and produces acetyl Co-A. This process is known as gluconeogenesis (generation of glucose from a non-carbohydrate compound). Excessive production of acetyl-CoA leads to the production of ketone bodies.

Glycogenesis: Process of formation of glycogen in the presence of insulin. In insulin deficiency, it will not occur. Diabetic ketoacidosis, the liver produces more ketones

The answer is a. uncontrolled gluconeogenesis during the absorptive and post-absorptive state

7. Type I diabetes: beta cells (insulin-secreting cells) of pancreases are destroyed leads to less or no insulin in the blood result in hyperglycemia. Type I diabetes is typically treated with exogenous insulin, not with insulin sensitizers. Type II diabetes is insulin resistant not type 1

The answer is a. Type 1 debiatics cannot produce insulin

8. The gluconeogenic pathway is a synthesis of glucose from non-carbohydrate compounds like proteins and fats. Glycogen to glucose synthesis is not the gluconeogenic pathway since glucose is formed from carbohydrate glycogen. This process is called glycolysis.

When protein is breakdown into glucose ketone bodies will not be formed whereas when fats breakdown first long-chain fatty acids are formed then ketone bodies then to glucose

The answer is b. Fatty acid--- keto acid----glucose

9. If a patient is type 1-diabetic, then there will be hight ketone bodies in the blood which leads to a decrease in blood pH (acidosis).

The answer is c. Increased protein glycation (AGEs) within the plasma

10. A Postabsorptive state is also known as a fasting state. In this state, our body depends on stored glycogen. Here, glycogen breakdown into glucose - this process is known as glycolysis

The answer is a. Glycogen is being hydrolyzed releasing individual glucose monomers into the blood