Endocrine Weight Loss Insulin Resistance and Weight Management 2 — Questions and Answers
Question 1: Which physical activity type most effectively improves insulin sensitivity per session?
- Low-intensity stretching
- High-intensity interval training (HIIT) (Correct answer)
- Moderate-pace walking under 30 minutes
- Light yoga
Correct answer: High-intensity interval training (HIIT)
HIIT has been shown to rapidly improve insulin sensitivity, increase GLUT4 expression in muscle, and reduce visceral fat more efficiently per unit time than moderate continuous exercise.
Question 2: A fasting glucose of 105 mg/dL and 2-hour post-load glucose of 155 mg/dL on an OGTT would classify a patient as:
- Normal glucose tolerance
- Impaired fasting glucose with impaired glucose tolerance (prediabetes) (Correct answer)
- Type 2 diabetes
- Reactive hypoglycemia
Correct answer: Impaired fasting glucose with impaired glucose tolerance (prediabetes)
Impaired fasting glucose is 100–125 mg/dL; impaired glucose tolerance is a 2-hour OGTT value of 140–199 mg/dL; together they indicate prediabetes.
Question 3: Excess ectopic fat deposition in the liver (hepatic steatosis) promotes insulin resistance by:
- Increasing hepatic adiponectin secretion
- Generating diacylglycerol that activates PKC and impairs insulin receptor substrate signaling (Correct answer)
- Upregulating hepatic GLUT2 expression
- Suppressing hepatic gluconeogenesis
Correct answer: Generating diacylglycerol that activates PKC and impairs insulin receptor substrate signaling
Hepatic fat accumulation generates lipid metabolites (diacylglycerol, ceramides) that activate protein kinase C, which serine-phosphorylates IRS-1 and blunts insulin signaling.
Question 4: GLP-1 receptor agonists improve insulin resistance in obesity through all of the following EXCEPT:
- Reducing body weight and visceral fat
- Improving hepatic insulin sensitivity
- Directly stimulating insulin secretion in a glucose-independent manner (Correct answer)
- Reducing systemic inflammation
Correct answer: Directly stimulating insulin secretion in a glucose-independent manner
GLP-1 receptor agonists stimulate insulin secretion in a glucose-dependent manner (only when glucose is elevated), not in a glucose-independent manner, which minimizes hypoglycemia risk.
Question 5: Which dietary intervention has the strongest evidence for reducing hepatic fat and improving insulin sensitivity in metabolic syndrome?
- Low-fat, high-carbohydrate diet
- Mediterranean diet or low-carbohydrate diet (Correct answer)
- High-protein ketogenic diet only
- Intermittent fasting exclusively
Correct answer: Mediterranean diet or low-carbohydrate diet
Both Mediterranean and low-carbohydrate dietary patterns have robust evidence for reducing hepatic steatosis, improving insulin sensitivity, and reducing cardiovascular risk in metabolic syndrome.
Question 6: Polycystic ovary syndrome (PCOS) is most commonly associated with which underlying endocrine-metabolic defect?
- Primary adrenal insufficiency
- Hypothyroidism
- Insulin resistance and compensatory hyperinsulinemia (Correct answer)
- Growth hormone excess
Correct answer: Insulin resistance and compensatory hyperinsulinemia
The majority of women with PCOS have insulin resistance; the resulting compensatory hyperinsulinemia stimulates ovarian androgen production, driving the reproductive and metabolic features of PCOS.
Endocrine Weight Loss Insulin Resistance and Weight Management 2
Which physical activity type most effectively improves insulin sensitivity per session?