Type 1 diabetes
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Type 1 diabetes
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[post_date] => 2024-12-23 18:22:03
[post_date_gmt] => 2024-12-23 23:22:03
[post_content] => Practice Passage (Question 1-6)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
A young boy is brought to the emergency department. His parents recently noticed that he has been drinking large amounts of water and urinating frequently. He then developed a minor cold last week, and over the past few days he has become very ill. This morning, his parents had a difficult time waking him. In the emergency department the boy’s blood glucose level is measured to be 527 mg/dL (normal: 60 – 125 mg/dL), and he is diagnosed with type 1 diabetes mellitus.
Type 1 diabetes mellitus is an autoimmune disease that affects the pancreas’s ability to produce insulin. Since individuals with type 1 diabetes mellitus do not produce enough insulin, they are required to take insulin injections in order to properly regulate the body’s energy supply.
The boy recovers after a few days of treatment and is discharged home with prescription insulin, which he is told to take at bedtime and before each meal, as well as a glucose meter for monitoring his blood glucose levels from home. Two weeks later he returns to the emergency department, with a blood glucose level of 35 mg/dL (normal: 60 – 125 mg/dL). Figure 1 depicts his blood glucose measurements throughout the day prior to coming to the emergency department.
Figure 1 The boy’s blood glucose levels over the 24 hours prior to arriving in the emergency department
[post_title] => Type 1 diabetes
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[question] => When the boy returns to the emergency department (11:00 PM), what is the likely cause of his blood sugar level?
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[answer] => 4
[description] => Reason for Correct Answer:
The graph shows that the boy’s blood sugar level started to drop around 7 and continued to decrease to around 40 mg/dL around 11:00. This is very low – the passage defines normal blood sugar levels as 60-125 mg//dL.
The passage states that the boy had been sent home with insulin to control his diabetes.
Insulin is the hormone that causes the body to take glucose from the blood and convert it into storage forms of energy.
Insulin lowers the blood sugar level. (It works antagonistically with glucagon, which increases gluconeogenesis and glycogen breakdown, increasing blood sugar.)
Taking insulin without eating would result in a very low blood sugar level. Therefore, the boy likely took his insulin, but then did not eat dinner. This would result in a drop in blood sugar levels from the insulin, without counterbalance by eating
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[answers] => Array
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[0] => Array
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[each_answer] => A. He forgot to take his insulin before eating dinner.
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[1] => Array
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[each_answer] => B. His glucagon levels rose in response inadequate insulin production.
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[each_answer] => C. He took his insulin and ate a high sugar meal.
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[each_answer] => D. He took his insulin but then did not eat dinner.
)
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[1] => Array
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[quiz_unique_key] => 1403770772
[question] => Based on the findings in Figure 1, in regards to carbohydrate metabolism, what is the predominant process that is occurring in the boy’s body at 4:00 AM, and what is the rate-limiting enzyme?
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[answer] => 1
[description] => Reason for Correct Answer:
At 4:00 AM, in the middle of the night, the boy is in the presumably fasting (post-absorptive) metabolic state, but it looks like his blood sugar levels are staying relatively stable during this period.
During the fasting state, the liver breaks down glycogen to produce glucose. The process of breaking down glycogen into glucose is known as glycogenolysis.
Glycogen phosphorylase is the rate-limiting enzyme of glycogenolysis.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Glycogenolysis; glycogen phosphorylase
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[1] => Array
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[each_answer] => B. Glycolysis; glycogen phosphorylase
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[each_answer] => C. Glycogenolysis; phosphofructokinase
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[each_answer] => D. Glycolysis; phosphofructokinase
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[2] => Array
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[quiz_unique_key] => 1403770772
[question] => What hormone is responsible for maintaining the boy’s blood sugar level overnight?
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[answer] => 1
[description] => Reason for Correct Answer:
Overnight the boy’s body is in the fasting (post-absorptive) state.
During the post-absorptive state the body breaks down glycogen (glycogenolysis) and metabolizes other energy storage forms (ie. triglycerides, fat, and protein) into glucose.
Glucagon is the hormone that drives the metabolic reactions during the fasting state. Glucagon is responsible for maintaining the boy’s blood sugar level overnight.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Glucagon
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[each_answer] => B. Insulin
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[each_answer] => C. Adrenocorticotropin hormone (ACTH)
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[each_answer] => D. Aldosterone
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[quiz_unique_key] => 1403770772
[question] => If the boy forgets to take his insulin before breakfast, but still eats a meal high in carbohydrates, what metabolic process will be occurring in adipose tissue immediately after his meal?
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[answer] => 1
[description] => Reason for Correct Answer:
Insulin plays a crucial role in regulating both lipolysis (the breakdown of fats) and lipogenesis (the synthesis of new fats).
When insulin levels are high – such as after a meal in normal patients – it binds to insulin receptors on adipose tissue cells, leading to the activation of enzymes that inhibit lipolysis. Insulin also promotes uptake of glucose by adipose cells and stimulates the conversion of glucose into fatty acids (lipogenesis). Overall, insulin promotes fat storage by inhibiting lipolysis and promoting lipogenesis.
In the absence of insulin, even after a meal, lipolysis would continue to occur, despite the rise in blood sugar levels.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Lipolysis
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[1] => Array
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[each_answer] => B. Ketogenolysis
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[each_answer] => C. Lipogenesis
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[each_answer] => D. Triglyceride synthesis
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[quiz_unique_key] => 1403770772
[question] => One possible cause of type 1 diabetes would be:
[value] => Array
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[answer] => 3
[description] => Reason for Correct Answer:
The passage states that “Type 1 diabetes mellitus is an autoimmune disease that affects the pancreas’s ability to produce insulin.”
Insensitivity or unresponsiveness of insulin receptors (option A) is more characteristic of Type 2 diabetes, for which a chronic high sugar diet is one risk factor.
Destruction of pancreatic alpha cells would cause low glucagon levels, as these cells make glucagon.
Destruction of pancreatic beta cells, which produce insulin, would lead to inadequate insulin release, and this is a cause of type 1 diabetes.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. insensitivity or unresponsiveness of insulin receptors.
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[1] => Array
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[each_answer] => B. viral induced destruction of pancreatic alpha cells.
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[each_answer] => C. autoimmune destruction of pancreatic beta cells.
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[each_answer] => D. a chronic high sugar diet.<span
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[quiz_unique_key] => 426016249
[question] => What is the likely cause of the boy’s increased urination?
[value] => Array
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[answer] => 1
[description] => Reason for Correct Answer:
The passage states that the boy has been “urinating frequently,” and this is a typical side effect of diabetes.
Diabetes results in high blood sugar levels.
This, in turn, results in a higher amount of glucose entering the nephron, or a high filtration rate into the nephron and renal tubules.
This would create greater osmotic pressure in the renal tubules, if the filtration rate of glucose exceeds its reabsorption (back into the bloodstream), which occurs in the proximal convoluted tubule – the first segment of the nephron shown below.
https://commons.wikimedia.org/wiki/File:2618_Nephron_Secretion_Reabsorption.jpg
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[answers] => Array
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[each_answer] => A. High osmotic pressure in the renal tubules, due to a glucose filtration rate that exceeds glucose reabsorption in the proximal convoluted tubule
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[each_answer] => B. High osmotic pressure in the renal tubules, due to a glucose filtration rate that exceeds glucose reabsorption in the loop of Henle
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[each_answer] => C. Low osmotic pressure in the renal tubules, due to a glucose filtration rate lower than the rate of glucose reabsorption in the distal convoluted tubule
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[each_answer] => D. Low osmotic pressure in the renal tubules, due to a glucose filtration rate lower than the rate of glucose reabsorption in the collecting duct
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[554720|1] => D
[554720|2] => A
[554720|3] => A
[554720|4] => A
[554720|5] => C
[554720|6] => A
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Figure 1