Diabetes Type 1 Diabetes 3 — Questions and Answers
Question 1: A patient with Type 1 diabetes uses an insulin pump. Which insulin is used in continuous subcutaneous insulin infusion (CSII)?
- Long-acting insulin glargine
- Intermediate-acting NPH
- Rapid-acting insulin analog (Correct answer)
- Regular insulin only
Correct answer: Rapid-acting insulin analog
Insulin pumps use only rapid-acting insulin analogs (e.g., lispro, aspart, glulisine) delivered continuously as basal and in boluses for meals.
Question 2: Which complication is unique to Type 1 diabetes and rarely seen in Type 2?
- Diabetic nephropathy
- Peripheral arterial disease
- Diabetic ketoacidosis (Correct answer)
- Diabetic retinopathy
Correct answer: Diabetic ketoacidosis
DKA occurs almost exclusively in Type 1 diabetes due to absolute insulin deficiency, which drives unregulated ketogenesis.
Question 3: What is the carbohydrate-to-insulin ratio used for in Type 1 diabetes management?
- Calculating the basal insulin dose
- Determining the correction factor for hyperglycemia
- Calculating mealtime bolus insulin doses (Correct answer)
- Estimating HbA1c from glucose readings
Correct answer: Calculating mealtime bolus insulin doses
The carbohydrate-to-insulin ratio (e.g., 1 unit per 15g carbs) is used to calculate how much rapid-acting insulin to take with each meal.
Question 4: Which finding on urinalysis is an early marker of diabetic nephropathy in Type 1 diabetes?
- Gross hematuria
- Microalbuminuria (30–300 mg/day) (Correct answer)
- Glycosuria alone
- Bacteriuria
Correct answer: Microalbuminuria (30–300 mg/day)
Microalbuminuria (moderately increased albuminuria) is the earliest clinical marker of diabetic nephropathy and indicates glomerular damage.
Question 5: How does exercise typically affect blood glucose in a patient with Type 1 diabetes during aerobic activity?
- Always increases blood glucose
- Generally decreases blood glucose due to increased glucose uptake (Correct answer)
- Has no effect on blood glucose
- Only affects blood glucose if insulin is not taken
Correct answer: Generally decreases blood glucose due to increased glucose uptake
Aerobic exercise increases muscle glucose uptake independent of insulin, which typically lowers blood glucose and may require carbohydrate supplementation.
Question 6: What is the pathophysiological reason Type 1 diabetics develop ketoacidosis but Type 2 diabetics typically do not?
- Type 2 patients have more body fat to buffer ketones
- Type 1 patients have absolute insulin deficiency; even small amounts in Type 2 suppress ketogenesis (Correct answer)
- Type 2 kidneys excrete ketones more efficiently
- Type 1 patients consume more fat in their diet
Correct answer: Type 1 patients have absolute insulin deficiency; even small amounts in Type 2 suppress ketogenesis
Even residual insulin in Type 2 diabetes is sufficient to inhibit hepatic lipolysis and ketogenesis, whereas absolute deficiency in Type 1 allows uncontrolled fat breakdown.
Question 7: Which immunosuppressive approach has been FDA-approved to delay progression to Stage 3 Type 1 diabetes in at-risk individuals?
- Rituximab infusions
- Teplizumab (anti-CD3 antibody) (Correct answer)
- Cyclosporine therapy
- Mycophenolate mofetil
Correct answer: Teplizumab (anti-CD3 antibody)
Teplizumab, an anti-CD3 monoclonal antibody, was FDA-approved in 2022 to delay the onset of clinical Type 1 diabetes in high-risk Stage 2 individuals.
Diabetes Type 1 Diabetes 3
A patient with Type 1 diabetes uses an insulin pump.
Which insulin is used in continuous subcutaneous insulin infusion (CSII)?