History and Mystery
The hormone insulin was discovered in this year.
What is 1921?
Glucose: 480 mg/dL
pH: 7.1
Bicarbonate: 12 mEq/L
Serum ketones: positive
What is diabetic ketoacidosis (DKA)?
This common household technology inspired the first design of the modern insulin pump.
What is the Walkman cassette player?
A 16-year-old with T1D presents to the ED with high glucose but a normal pH and bicarb. The resident calls it DKA.
What is hyperglycemia without acidosis (NOT DKA)?
This Supreme Court Justice has lived with T1D since childhood.
Who is Sonia Sotomayor?
Before insulin, some children with T1D were treated with this extreme diet to prolong life.
What is the starvation/very-low-carb diet?
Fasting glucose: 110 mg/dL
2-hour OGTT: 160 mg/dL
HbA1c: 5.8%
What is prediabetes / impaired glucose tolerance?
This basal insulin has the longest duration of action and can be dosed once daily, sometimes twice, depending on patient variability.
What is insulin degludec?
A patient on an insulin pump has recurrent DKA episodes. The fellow keeps escalating basal insulin. The real issue is usually this.
What is infusion set/pump failure (kinked tubing, site issues, disconnection)?
This Jonas brother has T1D and co-founded the “Beyond Type 1” foundation.
Who is Nick Jonas?
This Nobel Prize–winning surgeon from Toronto was not the one who actually did the first insulin injections, but he gets most of the credit.
Who is Frederick Banting?
HbA1c: 11.2%
Glucose: 250–400 mg/dL (random)
C-peptide: low-normal
Autoantibodies: negative
What is late autoimmune diabetes of adulthood (LADA) or slowly progressive T1D)?
This peptide analog, rarely used but FDA-approved as adjunct therapy in Type 1 diabetes, slows gastric emptying and suppresses glucagon to blunt postprandial spikes.
What is pramlintide?
A T1D patient has rising glucose despite increasing basal insulin overnight. The fellow calls it “dawn phenomenon,” but it’s actually this.
What is the Somogyi effect (rebound hyperglycemia after nocturnal hypoglycemia)?
This Peanuts character was written into a special cartoon in the 1980s to help kids understand T1D.
Who is Sally Brown?
The very first batch of insulin given to humans was described as “impure” and caused this kind of reaction.
What is a severe allergic/abscess reaction at the injection site?
C-peptide: undetectable
Autoantibodies: positive (GAD65, IA-2)
Blood glucose: 220 mg/dL
What is type 1 diabetes?
A Type 1 diabetes patient is started on a GLP-1 receptor agonist off-label and reports reduced insulin needs but frequent post-meal hyperglycemia. The cause is most likely this pharmacologic effect.
What is delayed gastric emptying leading to a mismatch between insulin and nutrient absorption?
During illness, a fellow advises a T1D patient to stop insulin because they’re not eating. The dangerous consequence is this.
What is DKA (always need basal insulin, even if not eating)?
In the 1990s, this soft drink brand was sued after T1D patients claimed it caused false high glucose readings on urine tests.
What is Pepsi (because of sugar interference)?
The first human ever treated with insulin was named Leonard Thompson, and he was this age.
What is 14 years old?
Serum potassium: 6.2 mEq/L
Bicarbonate: 14 mEq/L
Glucose: 520 mg/dL
pH: 7.18
What is diabetic ketoacidosis with hyperkalemia (classic electrolyte pattern)?
During DKA management, the insulin infusion should not be stopped immediately when glucose normalizes. The infusion should continue until this biochemical parameter has resolved.
What is the closure of the anion gap?
A newly diagnosed T1D patient is still making some insulin. The fellow calls them “misdiagnosed type 2.” The correct explanation is this.
What is the honeymoon phase (transient partial remission)?
This unexpected food item was once studied as a way to “cure” T1D in mice (and hyped in the media).
What is cow’s milk (beta-casein hypothesis)?