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 usmle sample q 114  



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Author6 Posts
  #1

A 25-year-old woman with previously well
controlled type 1 diabetes mellitus develops
ketoacidosis 2 days after onset of a urinary tract
infection. The most likely cause of the
ketoacidosis is decreased efficacy of insulin on
muscle, adipose tissue, and liver resulting from
antagonism by which of the following
hormones?

answer is cortisol,

why not glucagon? i can't seem to find an answer.




  #2

ketoacidosis is a stress situation for the body, and any time the body undergoes stress, stress hormones are released, like cortisol.



  #3

will glucagon be released as well?


  #4

also cortisol inhibits ADH, prone to dehydration leading DKA.


  #5

glucogon is almost always present in type 1 DB. infection wouldnt directly coz glucogon secretion.


  #6

yes Glucagon is also released but Cortisol has a permissive action over it. Without Cortisol any stressful condition there would be fasting hypoglycemia. Now in a diabetic patient who is undergoing any stressful condition would be bombarded with stimuli to produce glucose. Intra-cellularly there is hypoglycemia and therefore to combat it Cortisol is released and also glucagon. But without the insulin the transport of glucose is not faciliated. Therefore continously the Cortisol is released to combat such issues. High levels of B-oxidation of fatty acids results in synthesis of Ketone bodies so the skeletal and cardiac tissues can utliize them for energy.

The biggest issue for Diabetics is that they may be in a well fed state but intracellularly the body is going to starvation state. Thus resulting in downwards spiral of DKA.






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