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1- which of the following statements regarding general principles of glucose metabolism are correct? Please select all that apply. a) Gluconeogenesis is the formation of glucose from glycogen. b) Glycogen may be stored as glucose or converted to fat. c) Glycogenolysis and gluconeogenesis are functions of the liver. d) Gluconeogenesis is stimulated when plasma glucose is low. e) Glycogenesis is stimulated when cellular ATP reserves are low. Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates. From breakdown of proteins, these substrates include glucogenic amino acids (although not ketogenic amino acids); from breakdown of lipids (such as triglycerides), they include glycerol (although not fatty acids); and from other steps in metabolism they include pyruvate and lactate. Glycogenolysis is the biochemical breakdown of glycogen to glucose whereas glycogenesis is the opposite, the formation of glycogen from glucose. Glycogenolysis takes place in the cells of muscle and liver tissues in response to hormonal and neural signals. In particular, glycogenolysis plays an important role in the adrenaline-induced fight-or-flight response and the regulation of glucose levels in the blood. The reverse process, glycogenesis, the formation of glycogen from glucose, occurs in liver and muscle cells when glucose and ATP are present in relatively high amounts. In the synthesis of glycogen, one ATP is required for every glucose unit incorporated into the polymeric branched structure of glycogen. The glucose (in the form of glucose-6-phosphate) is synthesized directly from glucose or as the end product of gluconeogenesis. The polysaccharide structure represents the main storage form of glucose in thebody. In humans, glycogen is made and stored primarily in the cells of the liver and the muscles, hydrated with three or four parts of water. 2- A person has been on hunger strike for a week. Which of the following statements will apply to him? Please select all that apply. a) Increased release of fatty acids from adipose tissue. b) Formation of protein. c) Elevated plasma glucose. d) Increased activity of hepatic glycogen synthetase. e) Increased plasma catecholamine levels. The First Phase of Starvation During the first stage of starvation, blood glucose levels are maintained through the production of glucose from proteins, glycogen and fats. At first, glycogen is broken down into glucose. Only enough glycogen; however, is stored in the person's liver to last a few hours. After that period of time, blood glucose levels are maintained by the breakdown of fats and proteins. Fats are decomposed into glycerol and fatty acids. Fatty acids can be used as a source of energy, particularly by skeletal muscle, thereby decreasing the use of glucose by tissues other than the brain. Glycerol may be used to make a small amount of glucose, yet most of the glucose is formed from the amino acids of proteins. Some amino acids might be used directly for energy. The Second Phase of Starvation In the second phase, which might last for several weeks, fats are the main energy source. A person's liver metabolizes fatty acids into ketone bodies that can be used as a source of energy. After approximately a week of fasting, a person's brain starts to use ketone bodies, as well as glucose, for sources of energy. Proteins not essential for survival are used first. The Third Phase of Starvation The third phase of starvation starts when a person's fat reserves are depleted and there is a switch to proteins as the major source of the person's energy. Muscles, the largest source of protein in the body, are quickly depleted. At the end of this phase, proteins - essential for cellular functions, are broken down and cell function degenerates. Along with loss of weight, symptoms of starvation include: • Apathy • Withdrawal • Listlessness • Increased susceptibility to disease Few people die directly from starvation because they usually die of an infectious disease first. Additional signs of starvation may include flaky skin, changes in hair color and massive edema in the lower limbs and abdomen, causing the person's abdomen to seem bloated. During the process of starvation, the ability of the human body to consume volumes of food also decreases. Foods low in protein yet high in bulk often times cannot reverse the process of starvation. Intervention involves feeding the affected person low-bulk food that provides lots of proteins and kilo-calories and is fortified with minerals and vitamins. The process of starvation also results in dehydration and dehydration is an important part of intervention. Even with intervention, a person might be so affected by weakness or disease they do not have the ability to make a recovery. The body has 3 energy sources: carbohydrates (stored as glycogen), protein andfats. It burns them preferentially in that order because of the energy requirements to both store and break them down. ... The result is the same, but more profound -muscle loss first then fat loss. 3- Regarding diabetes mellitus, which of the following statements are correct? Please select all that apply. a) It may be caused by a reduction in functional insulin receptors b) It is characterized by a fall in urine output. c) It is associated with an increase in lipolysis. d) It leads to hypoglycaemia. e) It is a common symptom of conns 4- Diabetes often results due to conversion of glucose to glycogen inability of pancreas to secrete insulin less water intake in diet unhealthy and inactive life styles 5- In a healthy person, excess glucose is stored inside body converted to glycogen excreted in urine not present in diet 6- Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except: Polyphagia Hypoglycemia Ketonuria Hyponatremia 7- A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? Respiration Pulse Temperature BP 8- When a client is in diabetic ketoacidosis, the insulin that would be administered is: Human NPH insulin Insulin lispro injection Human regular insulin Insulin glargine injection 9- Insulin forces which of the following electrolytes out of the plasma and into the cells? Calcium Magnesium Potassium Phosphorus 10- Which of the following chronic complications is associated with diabetes? Retinopathy, neuropathy, and coronary artery disease Leg ulcers, cerebral ischemic events, and pulmonary infarcts Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s Dizziness, dyspnea on exertion, and coronary artery disease 11- Rotating injection sites when administering insulin prevents which of the following complications? Systemic allergic reactions Insulin resistance Insulin lipodystrophy Insulin edema 12- Insulin causes the blood glucose levels to fall, but glucagon causes those levels to rise. The relationship between the two hormones would be said to be _____. expressive antagonistic synergistic permissive 13- The risk factors for type 2 diabetes mellitus include _____. being overweight family history All of the options listed are correct. being a member of a high-risk population 14- The risk factors for type 1 diabetes mellitus include _____. inactivity being overweight family history All of the options listed are correct. 15- When a pregnant woman develops diabetes mellitus it is called _____. Diabetes insipidus Type 2 diabetes mellitus Type 1 diabetes mellitus Gestational diabetes 16- Type 2 diabetes can be prevented or delayed through _____. Lifestyle interventions Exercise Weight loss All of the options listed are correct. 17- The primary risk factor for type 2 diabetes is _____. Viral infection Family history Obesity Being a member of a high risk population 18- Physical symptoms of type 1 diabetes include _____. unexplained weight loss increased thirst frequent urination All of the symptoms listed are correct. 19- After a meal, blood glucose levels increase and stimulate the secretion of which hormone? glucagon glycogen pancreatisome insulin 20- Midmorning, blood glucose levels fall and stimulate the secretion of which hormone? insulin glucagon glycogen pancreatisome 21- Type 1 diabetes _____. occurs only with obesity lowers cells' sensitivity to insulin involves the immune system attacking and killing pancreas cells that make insulin occurs only in adults 22- Long-term complications of diabetes include _____. increased risk for high blood pressure and atherosclerosis increased risk for kidney failure impaired sensation in the hands and feet All the complications listed are correct. 23- A fasting blood glucose test level of _________________ is considered normal. 4 mmol/L to 7 mmol/L 4 mmol/L to 6 mmol 2.8 mmol/L to 5 mmol/L 8 mmol/L or higher on two separate tests 24- A fasting blood glucose test level of _________________ indicates diabetes. 2.5 mmol/L to 3.5 mmol/L 5 mmol/L to 7mmol/L 6 mmol/L to 7 mmol/L 7 mmol/L or higher on two separate tests 25- A fasting blood glucose test level of _________________ indicates prediabetes. 5 mmol/L to 6 mmol/L 7 mmol/L to 9 mmol/L 6.1 mmol/L to 7 mmol/L 126 mg/dl or higher on two separate tests 26- The pathogenesis of hyperglycemia in diabetic ketoacidosis includes all the following mechanisms except for: a. Increased glycogenolysis in the liver and Increased gluconeogenesis in the kidneys b. Increased lipolysis in the kidney c. Increased serum glucagon d. Increased gluconeogenesis in adipose tissue e. Decreased glucose uptake from the muscles Gluconeogenesis is a ubiquitous process, present in plants, animals, fungi, bacteria, and other microorganisms.[2] In vertebrates, gluconeogenesis takes place mainly in the liver and, to a lesser extent, in the cortex of the kidneys. Diabetic ketoacidosis arises because of a lack of insulin in the body. The lack of insulin and corresponding elevation of glucagon leads to increased release of glucose by the liver (a process that is normally suppressed by insulin) from glycogen via glycogenolysis and also through gluconeogenesis. High glucose levels spill over into the urine, taking water and solutes (such as sodium and potassium) along with it in a process known as osmotic diuresis.[2] This leads to polyuria, dehydration, and compensatory thirst and polydipsia. The absence of insulin also leads to the release of free fatty acids from adipose tissue (lipolysis), which are converted through a process called beta oxidation, again in the liver, into ketone bodies (acetoacetate and β-hydroxybutyrate). βHydroxybutyrate can serve as an energy source in the absence of insulin-mediated glucose delivery, and is a protective mechanism in case of starvation. The ketone bodies, however, have a low pKa and therefore turn the blood acidic (metabolic acidosis). The body initially buffers the change with the bicarbonate buffering system, but this system is quickly overwhelmed and other mechanisms must work to compensate for the acidosis.[2] One such mechanism is hyperventilation to lower the blood carbon dioxide levels (a form of compensatory respiratory alkalosis). This hyperventilation, in its extreme form, may be observed as Kussmaul respiration.[7] In various situations such as infection, insulin demands rise but are not matched by the failing pancreas. Blood sugars rise, dehydration ensues, and resistance to the normal effects of insulin increases further by way of a vicious circle.[2][5] 27- Which of the following symptoms/signs are included in the clinical features of diabetic ketoacidosis? a. Polyuria and weight loss b. Tachypnea and tachycardia c. Abdominal pain and vomiting d. Cheyne – Stokes respiration e. All of the above f. a + b + c 28- What is true concerning potassium in diabetic ketoacidosis? a. Potassium replacement may not be necessary if its level is normal at initial management of DKA b. Potassium defi ciency may cause tall, peaked symmetrical T waves in the electrocardiogram c. Potassium replacement is necessary during the whole time period of IV fl uid administration d. Potassium defi ciency is the cause of hyponatremia observed at presentation of DKA 29- Untreated diabetes may result in all of the following except: a. Blindness b. Cardiovascular disease c. Kidney disease d. Tinnitus 30- Prediabetes is associated with all of the following except: a. Increased risk of developing type 2 diabetes b. Impaired glucose tolerance c. Increased risk of heart disease and stroke d. Increased risk of developing type 1 diabetes 31- Diabetics are at increased risk of heart disease if they also: a. Smoke b. Have high HDL cholesterol levels c. Take aspirin d. Consume a high-fiber diet 32- Blood sugar is well controlled when Hemoglobin A1C is: a. Below 7% b. Between 12%-15% c. Less than 180 mg/dL d. Between 90 and 130 mg/dL 33- Excessive thirst and volume of very dilute urine may be symptoms of: a. Urinary tract infection b. Diabetes insipidus c. Viral gastroenteritis d. Hypoglycemia 34- Among female children and adolescents, the first sign of type 1 diabetes may be: a. Rapid weight gain b. Constipation c. Genital candidiasis d. Insomnia 35- Which of the following measures does not help to prevent diabetes complications? a. Controlling blood glucose b. Controlling blood pressure and blood lipids c. Eliminating all carbohydrates from the diet d. Prompt detection of diabetic eye and kidney disease