Education Pathophysiology and Treatment Flashcards

In a patient with gastroparesis and type 1 diabetes, which insulin timing strategy is most appropriate for mealtime bolus doses?

Answer: Give rapid-acting insulin immediately before or even after eating

Gastroparesis delays gastric emptying unpredictably, so administering rapid-acting insulin after eating (or immediately before) reduces the risk of hypoglycemia from a mismatch between insulin peak and glucose absorption.

Which mechanism explains why hyperglycemia promotes cardiovascular disease in diabetes?

Answer: Advanced glycation end-products (AGEs) promote vascular inflammation and endothelial dysfunction

AGEs formed from non-enzymatic glycation of proteins cross-link vascular collagen, activate inflammatory pathways, and impair endothelial nitric oxide production, accelerating atherosclerosis.

A patient with type 2 diabetes has an eGFR of 30 mL/min/1.73m². Which diabetes medication is CONTRAINDICATED?

Answer: Metformin

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to risk of lactic acidosis from reduced renal clearance of the drug.

The pathophysiology of diabetic peripheral neuropathy involves which primary mechanism?

Answer: Hyperglycemia-induced oxidative stress and polyol pathway activation damaging nerve fibers

Chronic hyperglycemia activates the polyol pathway, generating sorbitol and fructose, depleting NADPH and glutathione, causing oxidative stress that damages both myelin and axons of peripheral nerves.

Which statement correctly describes the action of pramlintide (Symlin) in diabetes treatment?

Answer: It is a synthetic amylin analogue that suppresses glucagon and slows gastric emptying

Pramlintide mimics amylin, a co-secreted beta cell hormone, suppressing post-meal glucagon release, slowing gastric emptying, and promoting satiety to reduce post-prandial hyperglycemia.

In hyperglycemic hyperosmolar state (HHS), the primary distinguishing feature from DKA is:

Answer: Absence of significant ketoacidosis due to sufficient residual insulin to inhibit lipolysis

In HHS, residual insulin secretion (even if insufficient for glucose control) is enough to suppress hepatic ketogenesis and lipolysis, preventing significant ketonemia and acidosis.

When teaching a patient about the dawn phenomenon, the diabetes educator should explain that morning hyperglycemia is caused by:

Answer: Physiologic overnight surge of growth hormone and cortisol that increases insulin resistance

Growth hormone and cortisol, which peak in the early morning hours, increase hepatic glucose production and reduce insulin sensitivity, causing the dawn phenomenon in people with diabetes.