Diabetes Type 1 Diabetes 5 — Questions and Answers
Question 1: Which condition must be distinguished from Type 1 diabetes in a lean adult presenting with hyperglycemia and poor response to oral agents?
- Type 2 diabetes with insulin resistance
- LADA (Latent Autoimmune Diabetes in Adults) (Correct answer)
- Maturity-onset diabetes of the young (MODY)
- Gestational diabetes
Correct answer: LADA (Latent Autoimmune Diabetes in Adults)
LADA is an autoimmune diabetes in adults that progresses slowly and is often misclassified as Type 2; positive GAD antibodies confirm the diagnosis.
Question 2: What is the primary reason patients with Type 1 diabetes must never stop taking insulin, even when not eating?
- Insulin prevents muscle wasting during fasting
- Basal insulin is needed to suppress ketogenesis even without food intake (Correct answer)
- Insulin maintains blood pressure during fasting
- Insulin prevents electrolyte imbalances when fasting
Correct answer: Basal insulin is needed to suppress ketogenesis even without food intake
Without basal insulin, uncontrolled lipolysis and hepatic ketogenesis occur even in the fasted state, leading to DKA regardless of carbohydrate intake.
Question 3: Which technology continuously monitors interstitial glucose and alerts for predicted hypoglycemia in Type 1 diabetes?
- Traditional glucometer with test strips
- Continuous glucose monitor (CGM) (Correct answer)
- A1c point-of-care test
- Urine dipstick glucose test
Correct answer: Continuous glucose monitor (CGM)
Continuous glucose monitors (CGMs) measure interstitial glucose every 1–5 minutes and can alert users to impending hypoglycemia or hyperglycemia in real time.
Question 4: What is the 'honeymoon phase' in newly diagnosed Type 1 diabetes?
- Initial period of excellent glucose control requiring no insulin
- Temporary remission with reduced insulin needs due to residual beta-cell function (Correct answer)
- Phase where autoantibodies disappear from circulation
- Period of increased risk for DKA after diagnosis
Correct answer: Temporary remission with reduced insulin needs due to residual beta-cell function
The honeymoon phase is a period of temporary partial remission after diagnosis when remaining beta cells produce enough insulin to reduce exogenous insulin requirements significantly.
Question 5: In a Type 1 diabetic patient, hyperkalemia can develop during DKA primarily because of which mechanism?
- Increased dietary potassium intake
- Insulin deficiency causing potassium to shift out of cells into the bloodstream (Correct answer)
- Renal retention of potassium due to aldosterone excess
- Metabolic alkalosis driving potassium extracellularly
Correct answer: Insulin deficiency causing potassium to shift out of cells into the bloodstream
Insulin normally drives potassium into cells; its absence in DKA causes transcellular potassium shift out of cells, raising serum potassium despite total body potassium depletion.
Question 6: Which statement best describes the relationship between Type 1 diabetes and other autoimmune conditions?
- Type 1 diabetes patients have no increased risk of other autoimmune diseases
- Type 1 diabetes is associated with increased risk of thyroid disease, celiac disease, and Addison's disease (Correct answer)
- Only celiac disease co-occurs with Type 1 diabetes
- Autoimmune risk decreases after insulin therapy is started
Correct answer: Type 1 diabetes is associated with increased risk of thyroid disease, celiac disease, and Addison's disease
Type 1 diabetes shares genetic and immunologic pathways with other autoimmune conditions, significantly increasing risk of Hashimoto's thyroiditis, celiac disease, and adrenal insufficiency.
Question 7: What is the recommended screening interval for diabetic retinopathy in a patient with Type 1 diabetes after initial diagnosis in adulthood?
- Every 5 years if no retinopathy found
- Within 5 years of diagnosis then annually (Correct answer)
- Only when visual symptoms develop
- Every 6 months from the time of diagnosis
Correct answer: Within 5 years of diagnosis then annually
ADA guidelines recommend an initial dilated eye exam within 5 years of Type 1 diabetes diagnosis in adults, then annually thereafter to detect early retinopathy.
Diabetes Type 1 Diabetes 5
Which condition must be distinguished from Type 1 diabetes in a lean adult presenting with hyperglycemia and poor response to oral agents?