NBME Step 2 CK Form 6 Insulin (NBME Answers)

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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#41 (reveal difficulty score)
A previously healthy 52-year-old man comes to ...
Insulin 🔍 / 📺 / 🌳 / 📖
tags: endo inc

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submitted by ∗sugaplum(487)

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I missed this the first time because I wasn't thinking about it right. This man has new onset Type 2 diabetes. This is characterized by Insulin resistance, so initially the patient's body will increase insulin production to combat the new diabetes

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medicalmike Does T2DM cause weight loss? I interpreted this older man with weight loss and new-onset T2DM as having pancreatic cancer. +

kingfriday i guess if you dont get the anabolic benefit of insulin, you can't build up your weight- at least that's how i took it +1

ronabobonafofona Did the same thing @sugaplum +

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submitted by ∗step_prep7(71)

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Clinical picture consistent with Type 2 diabetes (older overweight man with polyuria, nocturia and increased non-fasting serum glucose concentration)
Key idea: Early on in Type 2 diabetes, insulin levels are high because the pancreas is trying to make up for the insulin-resistance
Key idea: Later on in Type 2 diabetes (on the scale of years after initial diagnosis), insulin levels become low as the beta cells become burned out from overproducing insulin for so long and secondary to amylin deposition within pancreas (amyloidosis)

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submitted by ∗kingfriday(45)

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Man I don't know what I was thinkin - i was between glucagon and insulin and then the panic set in. If you have high glucose (in the setting of diabetes) then you're going to suppress the hormone that releases more sugar and increase the hormone that will store more sugar.

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kingfriday DDX- bicarb will be normal[ish] in HHS and decreased in DKA, HDL-cholesterol? i dont know why that would play a role here, Ketones would be increased in DKA in type 1; i think it went something like people with Type 1 can't make insulin so glucagon is unopposed which breaks down fats -> ketones. In Type 2, you still have insulin around so it can suppress glucagon and thus no ketones. +

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