Deck 33: Diabetes

Question 1

The syndrome that is considered a collection of associated clinical and laboratory findings that include insulin resistance,hyperinsulinemia,obesity,high triglyceride and low high-density lipoprotein (HDL)cholesterol,and hypertension is the:

A) glucotoxic syndrome.
B) type 1A diabetes mellitus syndrome.
C) glucose counter-regulatory syndrome.
D) insulin resistance syndrome.

Answer 1

insulin resistance syndrome.

Question 2

The development of ketoacidosis in an uncontrolled diabetic is caused by the:

A) elevated presence of lactic acid.
B) increased formation of $\beta$ -hydroxybutyric acid.
C) loss of regulation of certain diabetogenes.
D) decreased number of insulin receptors on certain cells.

Answer 2

increased formation of $\beta$ -hydroxybutyric acid.

Question 3

Factors identified as associated with (and possibly causing)type 1 diabetes mellitus include all of the following except:

A) autoimmune reaction.
B) insulin resistance.
C) genetic factors.
D) absolute deficiency of insulin.

Answer 3

insulin resistance.

Question 4

Insulin deficiency in diabetes mellitus will cause:

A) increased insulin resistance and hyperglycemia.
B) increased glucose uptake by cells leading to hyperglycemia and cell death.
C) decreased lipolysis leading to ketosis.
D) increased glucagon concentration,which contributes to hyperglycemia and ketosis.

Question 5

Glucagon is made by the $\alpha$ -cells in the pancreas and when released causes elevated blood glucose.By what mechanism does glucagon promote hyperglycemia?

A) Glucagon promotes hypoglycemia,not hyperglycemia.
B) Glucagon stimulates insulin release.
C) Glucagon promotes glycogenesis in all cells.
D) Glucagon stimulates glycogenolysis and gluconeogenesis.

Question 6

As a counter-regulator of glucose metabolism in a healthy individual,epinephrine has the effect of _____ blood glucose.

A) breaking down glucose to form glycogen to increase
B) inducing liver gluconeogenesis to decrease
C) increasing glucose uptake by cells to decrease
D) stimulating glycogenolysis to increase

Question 7

The role of the clinical laboratory in diagnosis of diabetes mellitus involves initial diagnostic criteria.For many years,the only diagnostic criterion required was demonstration of hyperglycemia in two or more fasting plasma glucose tests.What other laboratory analysis is now considered to be useful as a diagnostic criterion?

A) Demonstration of impaired glucose tolerance in the OGTT
B) Consistent hyperglycemia after a 72-hour fast
C) Presence of ketones in urine on more than one occasion
D) Demonstration of elevated hemoglobin A_1c

Question 8

A pregnant woman at 27 weeks gestation is screened for gestational diabetes mellitus.Plasma venous glucose was measured at 1 hour following a 50 g oral glucose load.What value must this glucose be above or equal to for a glucose tolerance test to be performed?

A) The value must be remain within healthy glucose reference interval.
B) The value must be
140 mg/dL glucose.
C) The value must be
200 mg/dL glucose.
D) The value must be

Question 9

Retinopathy,neuropathy,microvascular,and macrovascular changes are all chronic complications of both type 1 and type 2 diabetes mellitus.One theory as to the cause of these chronic problems is the elevation of advance glycation end (AGE)products.These AGE products consist of:

A) glucose transporter proteins that promote the uptake of glucose from the lumen of the small bowel.
B) hemoglobin that has a glucose attached to the N-terminal valine residue of either $\beta$ -chain of hemoglobin A.
C) proteins that have been irreversibly modified by nonenzymatic attachment of glucose.
D) glycated genes that contribute to the development of diabetes and the formation of diabetogenes.

Question 10

Hb A_1c makes up approximately what percentage of total Hb A₁?

A) 10%
B) 25%
C) 50%
D) 80%

Question 11

Which one of the following 2-hour plasma glucose oral glucose tolerance test (OGTT)results would be classified as diagnostic for impaired glucose tolerance if an individual's fasting blood glucose value is 120 mg/dL (healthy glucose reference interval is 74 to 99 mg/dL)?

A) 195 mg/dL
B) 105 mg/dL
C) 130 mg/dL
D) 75 mg/dL

Question 12

A woman visits her physician with a complaint of polyuria and polydipsia.She has a family history of type 2 diabetes mellitus and is concerned that she is developing the disease.The physician notes that her previous hemoglobin A_1c (Hb A_1c)value was 6% (considered within healthy reference interval in the physician's practice)with a fasting plasma glucose of 95 mg/dL.At this visit,her Hb A_1c value is 8.5%.Why would the physician be correct to order an oral glucose tolerance test (OGTT)for this individual?

A) The Hb A_1c result indicates that glycation of proteins has increased producing elevated advanced glycation end products and the possible onset of type 2 diabetes.An OGTT would help to confirm this.
B) The Hb A_1c result indicates that diabetic nephropathy is occurring,signaling the possible onset of type 2 diabetes.An OGTT would help to confirm this.
C) The Hb A_1c result indicates an increase in average blood glucose and possible onset of type 2 diabetes.An OGTT would help to confirm this.
D) The physician would not be correct in ordering an OGTT because there is no indication that there is an onset of type 2 diabetes from the given laboratory values.

Question 13

Glycated hemoglobins are formed by the addition of glucose to the ___-terminal _____ residue.

A) C; valine
B) N; valine
C) C; alanine
D) N; alanine

Question 14

A fingerstick glucose value was 120 mg/dL.If unhemolyzed serum or plasma were tested from the same individual at the same time,what might the glucose value be?

A) Approximately 132 mg/dL
B) Approximately 100 mg/dL
C) Approximately 60 mg/dL
D) There would be no difference.

Question 15

An individual with a severe,uncontrolled case of type 1 diabetes mellitus will exhibit all of the following laboratory results except:

A) hyperlipidemia.
B) hyperglycemia.
C) hyperinsulinemia.
D) decreased blood pH with increased ketone bodies.

Question 16

Which of the following is characteristic of type 1A diabetes mellitus?

A) Normal blood insulin levels
B) Lack or decrease of functional insulin receptors on cells
C) Circulating autoantibodies formed against pancreatic insulin-secreting cells.
D) Individuals with this type of diabetes are not prone to ketosis.

Question 17

In uncontrolled diabetes mellitus,excess ketones are present in the blood and urine because of:

A) decreased lipid formation.
B) increased glycolysis.
C) increased breakdown of lipids (lipolysis).
D) increased glucose uptake into cells.

Question 18

Insulin regulates blood glucose levels by:

A) enhancing glycogenolysis,gluconeogenesis,and ketogenesis in the liver.
B) stimulating gluconeogenesis and increasing the breakdown of protein and fat.
C) inhibiting release of growth hormone from the pituitary and inhibiting secretion of glucagon by the pancreas.
D) stimulating the translocation of a glucose transporter and promoting glucose uptake into skeletal muscle and fat.

Question 19

Type 2 diabetes mellitus:

A) is associated with resistance to the action of insulin.
B) is often initially observed in an individual with ketoacidosis.
C) is also referred to as gestational diabetes.
D) occurs less frequently than type 1 diabetes.

Question 20

Determining urinary albumin excretion (UAE)is critical in type 1 and type 2 diabetics because:

A) this indicates increased attachment of glucose to proteins,lipids,and nucleic acids that contribute to the microvascular complications of diabetes.
B) UAE increase indicates increased glycation of serum albumin that forms fructosamine and leads to ketoacidosis.
C) increased UAE is highly predictive of and is thought to precede diabetic nephropathy and end-stage renal disease.
D) it assesses the long-term blood glucose concentration in a diabetic to monitor glucose control over an 8- to 12-week period.

Question 21

MATCHING
Match the substance with the effect it has on blood glucose concentration.
C-peptide

A)Increases
B)Decreases
C)Has no effect

Question 22

Which one of the following antibodies is found most commonly in over 90% of children who develop type 1 diabetes before 5 years old?

A) Islet cell cytoplasmic antibodies
B) Insulin autoantibodies
C) Insulinoma-associated antigens
D) Zinc transporter ZnT8

Question 23

High albuminuria is defined as:

A) a large albumin molecule that is present only in urine and that is measured by the lab in preclinical screening for diabetes.
B) an albumin molecule that is larger and less functional because of the effects of hyperglycemia that is measured by the laboratory in the clinical diagnosis of diabetes.
C) increased urinary albumin excretion between the range of 20 to 200 µg/min that is measured by the laboratory in the chronic management of diabetes mellitus.
D) a long-lived glycated albumin molecule found in the urine of a type 2 diabetic and measured by the laboratory in the acute management of a diabetic.

Question 24

Although not a routine clinical laboratory screening test,measurement of insulin secretion in a potential diabetic is important because:

A) an increase in insulin indicates the onset of hypoglycemia and the presence of advanced glycation end products.
B) increased insulin leads to retinopathy,nephropathy,and neuropathy.
C) a decrease in insulin will cause overstimulation of the GLUT4 transporter and low blood glucose.
D) a decrease in glucose-stimulated insulin secretion is the first functional abnormality in both types of diabetes.

Question 25

The hyperglycemia observed in a diabetic causes many toxic effects such as retinopathy and nephropathy.Although it is unclear how these outcomes are caused by elevated blood sugar,it is thought that hyperglycemia:

A) causes increased serum osmolarity,which leads to decreased blood flow in the microvascular compartments in peripheral tissues.
B) causes increased production of advanced glycation end products,which might contribute to microvascular complications.
C) induces secretion of glucagon,which antagonizes insulin secretion and leads to destruction of the microvessels in the retina and kidney.
D) causes a hemolytic disease with shortened red blood cell survival,thus not providing enough oxygen to peripheral tissues.

Question 26

MATCHING
Match the substance with the effect it has on blood glucose concentration.
Exercise

A)Increases
B)Decreases
C)Has no effect

Question 27

MATCHING
Match the substance with the effect it has on blood glucose concentration.
Somatostatin

A)Increases
B)Decreases
C)Has no effect