Metabolism USMLE Step 1 Practice Question
A 28-year-old woman with type 1 diabetes presents with fatigue and polyuria. Vital signs: BP 118/76, HR 92, RR 18, Temp 37°C, SpO2 98%. She requires 0.8 units/kg/day insulin. A 52-year-old man post-total pancreatectomy for chronic pancreatitis requires only 0.3 units/kg/day insulin. HbA1c is 7.2% in both patients. Neither patient has diabetic ketoacidosis. C-peptide level is undetectable in both. Which mechanism best explains the insulin requirement difference between these patients?
Answer choices
- AInsulin receptor-mediated increases in glucagon release
- BProduction of insulin with abnormal structure
- CInsulin resistance
- DAdditional post-receptor defects
- EHyperglucagonemia in addition to insulin deficiencyCorrect answer
- FImpaired hepatic glycogen synthesis despite normal insulin signaling
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.