Education Pathophysiology and Treatment Flashcards

A type 1 diabetes patient using an insulin pump develops unexplained hyperglycemia. Which is the FIRST action to investigate?

Answer: Check the infusion site for occlusion, lipohypertrophy, or dislodgement

Infusion site problems (kinking, lipohypertrophy, air bubbles, dislodgement) are the most common cause of unexplained pump hyperglycemia and should be assessed before other interventions.

Which protein measurement best reflects average glycemic control over the preceding 2–3 weeks (useful when HbA1c is unreliable)?

Answer: Fructosamine

Fructosamine reflects glycation of serum proteins (primarily albumin) with a half-life of 2–3 weeks, making it useful in conditions like hemolytic anemia or hemoglobin variants that falsify HbA1c.

In the pathogenesis of diabetic nephropathy, which early structural change precedes microalbuminuria?

Answer: Glomerular basement membrane thickening and mesangial expansion

Glomerular basement membrane thickening and mesangial matrix expansion are the earliest histologic changes in diabetic nephropathy, occurring before microalbuminuria becomes detectable.

Which class of diabetes medication has been shown to reduce cardiovascular mortality and hospitalizations for heart failure in patients with established cardiovascular disease?

Answer: SGLT-2 inhibitors and GLP-1 receptor agonists

Multiple large cardiovascular outcomes trials (EMPA-REG, LEADER, SUSTAIN-6, CANVAS) demonstrated that SGLT-2 inhibitors and GLP-1 receptor agonists significantly reduce MACE, CV death, and HF hospitalizations.

A patient's continuous glucose monitor shows a Time in Range (TIR) of 58%. According to current consensus goals, this indicates:

Answer: Below the recommended target of ≥70% for most adults with diabetes

The international consensus goal for TIR (70–180 mg/dL) is ≥70% for most non-pregnant adults with diabetes; 58% falls short and warrants treatment adjustment.

Which of the following best explains why patients with long-standing type 1 diabetes can lose hypoglycemia awareness?

Answer: Repeated hypoglycemic episodes blunt the counter-regulatory and symptomatic response

Hypoglycemia-associated autonomic failure (HAAF) results from repeated hypoglycemia desensitizing the brain and adrenal medulla, raising the glycemic threshold for counter-regulatory responses and reducing warning symptoms.

When educating a patient about the mechanism of metformin, the educator correctly explains that it primarily works by:

Answer: Activating AMPK to reduce hepatic glucose production (gluconeogenesis)

Metformin activates AMP-activated protein kinase (AMPK), primarily in hepatocytes, suppressing gluconeogenesis and glycogenolysis, thereby reducing fasting hepatic glucose output.