Endocrinology: hyperosmolar hyperglycaemic state: practice question

A Physiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Physiology · Endocrinology: hyperosmolar hyperglycaemic state

Sample item

A 70-year-old with type 2 diabetes has glucose 900 mg/dL, osmolality 340 mOsm/kg and marked dehydration, but no ketones and a normal pH. Why is ketoacidosis absent?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Residual insulin is enough to suppress lipolysis and ketogenesis

In type 2 diabetes, enough insulin remains to restrain adipose lipolysis, so little fatty acid reaches the liver for ketone production, but it is not enough to control hepatic glucose output. In type 1 absence of insulin gives ketoacidosis.

Option by option

  • A. Cortisol is low

    Cortisol deficiency does not explain the lack of ketones.

  • B. Glucagon is completely absent

    Glucagon is raised in diabetes.

  • C. The liver cannot make ketones

    The liver is capable of making ketones when given fatty acids.

  • D. Residual insulin is enough to suppress lipolysis and ketogenesis (correct)

    Correct. Small amounts of insulin suppress lipolysis and ketones.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is D, Residual insulin is enough to suppress lipolysis and ketogenesis. In type 2 diabetes, enough insulin remains to restrain adipose lipolysis, so little fatty acid reaches the liver for ketone production, but it is not enough to control hepatic glucose output.

Why is "Cortisol is low" not the answer?

Cortisol deficiency does not explain the lack of ketones.

Why is "Glucagon is completely absent" not the answer?

Glucagon is raised in diabetes.

Why is "The liver cannot make ketones" not the answer?

The liver is capable of making ketones when given fatty acids.

What concept does this question test?

It tests Endocrinology: hyperosmolar hyperglycaemic state in Physiology. In type 1 absence of insulin gives ketoacidosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: hyperosmolar hyperglycaemic state?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.