Medical Emergencies · patient case question
Which statement best represents the pathophysiology of type 2 diabetes mellitus?
Patient case: Dry Mouth in a Cancer Survivor with Diabetes
Patient: 55-year-old male
Chief Complaint: “My mouth is always dry and food sticks to everything.”
Background: Type 2 diabetes mellitus, most recent HbA1c 8.4%. Prostate adenocarcinoma treated with external beam radiation directed to the pelvis 2 years ago, currently in remission with no evidence of recurrence. History of peptic ulcer disease. No radiation to the head or neck.
Medications: Metformin · Glipizide · Amitriptyline for diabetic neuropathy · Omeprazole
Vital Signs: BP 138/86 mmHg · HR 80 bpm · RR 16 · T 98.4°F
Findings: Dry, sticky mucosa with minimal salivary pooling in the floor of the mouth. Mirror adheres to the buccal mucosa. Multiple new cervical and root surface carious lesions. Fissured, erythematous tongue.
Show answer and explanation
Correct answer: B. Increased cellular resistance to insulin
- A. Incorrect. Autoimmune destruction of beta cells defines type 1 diabetes, which typically presents in childhood or adolescence with absolute insulin deficiency and a tendency to ketoacidosis.
- B. Correct. Type 2 diabetes begins with peripheral insulin resistance in muscle, liver, and adipose tissue. The pancreas compensates with hyperinsulinemia, and hyperglycemia emerges only when beta cell output can no longer keep pace with the demand.
- C. Incorrect. An insulinoma secretes excess insulin and causes hypoglycemia, the opposite metabolic problem.
- D. Incorrect. Cortisol excess describes Cushing syndrome, which can produce secondary hyperglycemia but is a distinct endocrine disorder with its own characteristic physical findings.
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