COMPREHENSIVE DIABETES MELLITUS:
PATHOPHYSIOLOGY, DIAGNOSIS & MANAGEMENT
FINAL EXAM STUDY GUIDE 2026-2027
What is the role of Glucagon-Like Peptide-1 (GLP-1) in glucose regulation?
Stimulates glucose-dependent insulin secretion, suppresses postprandial glucagon
secretion, and slows gastric emptying, reducing hypoglycemia risk and
postprandial glucose (PPG) levels.
How does Glucose-Dependent Insulinotropic Polypeptide (GIP) differ from GLP-
1?
GIP stimulates insulin secretion but does not inhibit glucagon secretion, has
negligible effect on gastric emptying, and does not significantly affect food intake
or body weight.
What happens to glucose reabsorption in the kidneys in Type 2 Diabetes Mellitus
(DM)?
Increased SGLT2 activity leads to more glucose reabsorption, worsening
hyperglycemia as the renal threshold for glucose excretion is exceeded.
What are the two types of Sodium-Glucose Co-Transporters (SGLT) and their
functions?
SGLT1 primarily absorbs glucose in the GI tract, while SGLT2 is exclusive to
kidneys and responsible for 90% of renal glucose reabsorption.
,What are the common symptoms of Type 1 DM at diagnosis?
Symptoms include polyuria, polydipsia, polyphagia, weight loss, and fatigue, often
accompanied by diabetic ketoacidosis (DKA).
What is the significance of measuring C-peptide levels in Type 1 DM?
C-peptide levels indicate the presence of endogenous insulin and functioning beta-
cells.
What is the impact of SGLT2 inhibitors on glucose levels?
SGLT2 inhibitors block glucose reabsorption in the kidneys, leading to increased
urinary glucose excretion and reduced plasma glucose levels.
What is the renal threshold for glucose excretion in healthy adults?
The renal threshold for glucose excretion is typically around 180-200 mg/dL.
What is the typical weight loss associated with amylin's effects over six months?
Amylin can induce weight loss of approximately 1-1.5 kg over six months.
What is the relationship between insulin resistance and beta-cell function in Type 2
DM?
,Insulin resistance leads to increased insulin secretion initially, but over time, beta-
cell function declines, resulting in reduced insulin levels.
What are the markers for Type 1 DM diagnosis?
Weight loss, ketonuria, and erratic blood glucose levels during insulin treatment
are key markers for Type 1 DM.
What is the significance of autoantibodies in Type 1 DM?
The presence of autoantibodies to insulin, GAD, islet antigen 2, or zinc transporter
8 indicates a higher risk for developing Type 1 DM.
What is the effect of glucagon secretion in diabetes?
In diabetes, glucagon secretion can be abnormally elevated during the postprandial
period, contributing to hyperglycemia.
How does the body compensate for increased filtered glucose in Type 2 DM?
The kidneys increase glucose reabsorption to compensate for higher filtered
glucose, which worsens hyperglycemia.
What is the incretin effect in relation to Type 2 DM?
The incretin effect refers to the phenomenon where glucose given orally stimulates
more insulin secretion than glucose given intravenously, primarily due to the
action of GI hormones like GLP-1 and GIP.
, How do incretins affect insulin secretion in patients without diabetes?
In patients without diabetes, about 50% of insulin secretion after a meal is due to
the stimulation of the pancreas by incretins.
What happens to the incretin effect in patients with Type 2 DM?
In patients with Type 2 DM, the incretin effect is reduced, leading to decreased
insulin secretion following meal ingestion.
What are the responses of GLP-1 in Type 2 DM?
In Type 2 DM, GLP-1 levels in response to a meal are reduced, but the insulin
secretory response to GLP-1 is preserved.
What are the responses of GIP in Type 2 DM?
In Type 2 DM, GIP levels in response to a meal may be normal or increased, but
the insulin secretory response to GIP is impaired or absent.
How does improvement in glycemia affect GIP sensitivity?
Improvement in glycemia can restore GIP sensitivity.
What is the correlation between DPP-4 activity and HbA1c in Type 2 DM?
PATHOPHYSIOLOGY, DIAGNOSIS & MANAGEMENT
FINAL EXAM STUDY GUIDE 2026-2027
What is the role of Glucagon-Like Peptide-1 (GLP-1) in glucose regulation?
Stimulates glucose-dependent insulin secretion, suppresses postprandial glucagon
secretion, and slows gastric emptying, reducing hypoglycemia risk and
postprandial glucose (PPG) levels.
How does Glucose-Dependent Insulinotropic Polypeptide (GIP) differ from GLP-
1?
GIP stimulates insulin secretion but does not inhibit glucagon secretion, has
negligible effect on gastric emptying, and does not significantly affect food intake
or body weight.
What happens to glucose reabsorption in the kidneys in Type 2 Diabetes Mellitus
(DM)?
Increased SGLT2 activity leads to more glucose reabsorption, worsening
hyperglycemia as the renal threshold for glucose excretion is exceeded.
What are the two types of Sodium-Glucose Co-Transporters (SGLT) and their
functions?
SGLT1 primarily absorbs glucose in the GI tract, while SGLT2 is exclusive to
kidneys and responsible for 90% of renal glucose reabsorption.
,What are the common symptoms of Type 1 DM at diagnosis?
Symptoms include polyuria, polydipsia, polyphagia, weight loss, and fatigue, often
accompanied by diabetic ketoacidosis (DKA).
What is the significance of measuring C-peptide levels in Type 1 DM?
C-peptide levels indicate the presence of endogenous insulin and functioning beta-
cells.
What is the impact of SGLT2 inhibitors on glucose levels?
SGLT2 inhibitors block glucose reabsorption in the kidneys, leading to increased
urinary glucose excretion and reduced plasma glucose levels.
What is the renal threshold for glucose excretion in healthy adults?
The renal threshold for glucose excretion is typically around 180-200 mg/dL.
What is the typical weight loss associated with amylin's effects over six months?
Amylin can induce weight loss of approximately 1-1.5 kg over six months.
What is the relationship between insulin resistance and beta-cell function in Type 2
DM?
,Insulin resistance leads to increased insulin secretion initially, but over time, beta-
cell function declines, resulting in reduced insulin levels.
What are the markers for Type 1 DM diagnosis?
Weight loss, ketonuria, and erratic blood glucose levels during insulin treatment
are key markers for Type 1 DM.
What is the significance of autoantibodies in Type 1 DM?
The presence of autoantibodies to insulin, GAD, islet antigen 2, or zinc transporter
8 indicates a higher risk for developing Type 1 DM.
What is the effect of glucagon secretion in diabetes?
In diabetes, glucagon secretion can be abnormally elevated during the postprandial
period, contributing to hyperglycemia.
How does the body compensate for increased filtered glucose in Type 2 DM?
The kidneys increase glucose reabsorption to compensate for higher filtered
glucose, which worsens hyperglycemia.
What is the incretin effect in relation to Type 2 DM?
The incretin effect refers to the phenomenon where glucose given orally stimulates
more insulin secretion than glucose given intravenously, primarily due to the
action of GI hormones like GLP-1 and GIP.
, How do incretins affect insulin secretion in patients without diabetes?
In patients without diabetes, about 50% of insulin secretion after a meal is due to
the stimulation of the pancreas by incretins.
What happens to the incretin effect in patients with Type 2 DM?
In patients with Type 2 DM, the incretin effect is reduced, leading to decreased
insulin secretion following meal ingestion.
What are the responses of GLP-1 in Type 2 DM?
In Type 2 DM, GLP-1 levels in response to a meal are reduced, but the insulin
secretory response to GLP-1 is preserved.
What are the responses of GIP in Type 2 DM?
In Type 2 DM, GIP levels in response to a meal may be normal or increased, but
the insulin secretory response to GIP is impaired or absent.
How does improvement in glycemia affect GIP sensitivity?
Improvement in glycemia can restore GIP sensitivity.
What is the correlation between DPP-4 activity and HbA1c in Type 2 DM?
