Education Pathophysiology and Treatment Flashcards

A patient with type 2 diabetes and obesity is being considered for bariatric surgery. Which mechanism most contributes to diabetes remission after Roux-en-Y gastric bypass?

Answer: Rapid nutrient delivery to the distal gut increasing GLP-1 secretion and improving beta cell function

Roux-en-Y bypass routes nutrients directly to the distal ileum, dramatically increasing GLP-1 and PYY secretion, which enhances insulin secretion and sensitivity — often achieving diabetes remission before significant weight loss occurs.

Which statement about C-peptide is most accurate for a diabetes educator to share?

Answer: C-peptide is co-secreted with insulin and reflects endogenous insulin production, helping distinguish type 1 from type 2

C-peptide is cleaved from proinsulin and secreted in equimolar amounts with endogenous insulin; since exogenous insulin has no C-peptide, low or absent levels confirm near-total beta cell failure as in type 1 diabetes.

In diabetic retinopathy, proliferative disease is characterized by:

Answer: Neovascularization driven by VEGF secretion from ischemic retina

Chronic retinal ischemia stimulates VEGF secretion, triggering abnormal neovascularization on the retinal surface and into the vitreous, which is the hallmark of proliferative diabetic retinopathy and the main cause of vision loss.

A 68-year-old patient with type 2 diabetes, heart failure with reduced ejection fraction (HFrEF), and eGFR of 52 is started on empagliflozin. The primary rationale beyond glycemic control is:

Answer: SGLT-2 inhibition reduces cardiac preload and afterload, improving HF outcomes and slowing CKD progression

Empagliflozin promotes osmotic diuresis (reducing preload) and mild natriuresis (reducing afterload), provides direct cardiac metabolic benefits, and slows CKD progression — effects demonstrated in EMPEROR-Reduced and EMPA-KIDNEY trials.

The ACCORD trial findings changed clinical practice by demonstrating that:

Answer: Targeting HbA1c below 6% in high-risk type 2 patients increased all-cause and cardiovascular mortality

The ACCORD trial was stopped early because the intensive arm (HbA1c <6%) showed a 22% increase in all-cause mortality compared to standard therapy, cautioning against very tight control in high-risk older adults.

Which complication of insulin therapy is caused by repeated injections into the same site and can reduce insulin absorption unpredictably?

Answer: Lipohypertrophy (fatty tissue buildup at injection sites)

Lipohypertrophy results from insulin's local lipogenic and mitogenic effects when injections are repeatedly administered in the same area, creating fibrous fatty tissue that absorbs insulin erratically.

A diabetes educator counseling a patient about sick-day rules should emphasize that patients with type 1 diabetes should:

Answer: Continue basal insulin, check ketones frequently, and increase monitoring even when not eating

During illness, stress hormones increase glucose and ketone production; stopping insulin risks DKA — patients must continue basal insulin, check blood glucose and urine/blood ketones every 2–4 hours, and contact their provider if ketones are moderate or high.