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IMF-022-01-0001-en	How is fuel regulation divided between insulin and glucagon with stress hormones across fed, fasting and illness states?	Insulin dominates the fed state, promoting storage and restraining fuel production, while glucagon and stress hormones defend fuel supply during fasting and illness.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0002-en	How does a rise in glucose trigger insulin release from pancreatic beta cells?	Rising adenosine triphosphate closes potassium channels, depolarising the membrane, which opens calcium channels and triggers insulin release; incretins amplify this glucose-dependent secretion.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0003-en	How does the source of glucose shift as a fast lengthens?	Liver glycogen is an early source overnight, but as fasting continues, gluconeogenesis from lactate, glycerol and amino acids becomes dominant.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0004-en	Why do severe infection, trauma, surgery or glucocorticoid treatment precipitate hyperglycaemia?	Catecholamines, cortisol and growth hormone mobilise fuel and oppose aspects of insulin action, exposing limited beta-cell reserve.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0005-en	How can recurrent hypoglycaemia make later episodes more dangerous?	Repeated episodes blunt autonomic warning, so counter-regulatory symptoms fail to alert the person and dangerous unawareness develops.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0006-en	Why is exogenous insulin essential for survival in type one diabetes, and what role do autoantibodies play?	Immune-mediated destruction of beta cells produces absolute insulin deficiency; autoantibodies support classification but are not the direct cause of tissue injury.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0007-en	How does type two diabetes progress from compensated insulin resistance to hyperglycaemia?	Beta cells first compensate with increased secretion, but glucotoxicity, lipotoxicity, islet stress and limited reserve eventually cause secretory failure and hyperglycaemia.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0008-en	Why does diabetes classification matter, and why can age or body size not settle it?	Treatment, inheritance and ketosis risk differ between types, and forms such as monogenic, pancreatic, drug-induced or gestational diabetes cannot be identified from age or size alone.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0009-en	Why can glycated haemoglobin misrepresent glucose exposure in some patients?	It estimates recent average exposure through red cells, so changes in red-cell lifespan, haemoglobin structure, pregnancy, kidney disease, transfusion or assay interference distort it.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0010-en	Why does preventing diabetic complications require more than glucose treatment?	Diabetes accelerates atherosclerosis through clustered hypertension, dyslipidaemia, inflammation, endothelial dysfunction, kidney disease and smoking, so eyes, kidneys, feet, pressure and lipids need direct care.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0011-en	Why does metformin cause little hypoglycaemia, whereas sulfonylureas often do?	Metformin reduces hepatic glucose production, while sulfonylureas stimulate insulin secretion, which can cause hypoglycaemia and weight gain.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0012-en	Through which actions do glucagon-like peptide one receptor agonists lower glucose and weight?	They increase glucose-dependent insulin, suppress glucagon, slow gastric emptying and reduce appetite; selected agents also improve cardiovascular outcomes.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0013-en	What adverse effects balance the heart and kidney benefits of sodium-glucose cotransporter two inhibitors?	Their glycosuria and natriuresis can cause genital infection and volume depletion, and they can cause ketoacidosis without extreme hyperglycaemia.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0014-en	How do basal and prandial insulin divide the work of glucose control?	Basal insulin restrains fasting hepatic glucose output, while prandial insulin covers meals and correction; needs vary with food, activity, stress, kidney clearance, steroids and residual secretion.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0015-en	What distinguishes adrenergic from neuroglycopenic features of hypoglycaemia?	Adrenergic features are tremor, sweating, palpitations, hunger and anxiety, whereas neuroglycopenia causes confusion, behavioural change, visual disturbance, seizure, coma or focal deficits.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0016-en	Why may sulfonylurea-associated hypoglycaemia need prolonged observation?	Hypoglycaemia can recur after initial correction, so prolonged observation and suppression of insulin release may be required.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0017-en	How does insulin deficiency in diabetic ketoacidosis produce a high-gap acidosis?	Without insulin restraint, lipolysis drives hepatic ketone production, and the ketoacids consume bicarbonate, producing high anion gap acidosis.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0018-en	Why is total-body potassium depleted in ketoacidosis even when initial serum potassium is normal or high?	Insulin deficiency, hypertonicity and acidaemia shift potassium out of cells, so the serum level masks losses of total-body stores.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0019-en	Why is glucose added during treatment of diabetic ketoacidosis?	Insulin must continue until ketogenesis and ketosis resolve, and added glucose allows this safely; normalising glucose alone does not prove resolution.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0020-en	Why does hyperosmolar hyperglycaemic state usually lack major ketosis despite severe hyperglycaemia?	Relative insulin deficiency is sufficient to restrain major ketogenesis but insufficient to control glucose, so osmotic diuresis dominates.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0021-en	Why is tonicity corrected cautiously in hyperosmolar hyperglycaemic state?	Rapid shifts in tonicity can worsen neurological injury, so circulation and water are restored gradually.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0022-en	Why is maintaining weight loss biologically difficult, and what does this imply about failure?	Weight loss increases hunger and lowers energy expenditure, creating biological resistance to maintenance that does not imply personal failure.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0023-en	How does insulin resistance alter the lipid profile?	It raises triglyceride-rich and small dense atherogenic particles while lowering high-density lipoprotein cholesterol.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending
IMF-022-01-0024-en	Why do normal aminotransferases not exclude significant liver disease in metabolic steatotic liver disease?	Aminotransferases can be normal despite significant fibrosis, so risk assessment combines metabolic context with non-invasive fibrosis estimates, imaging and specialist evaluation.	Integrated Medical Foundations; chapter 22, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: d714706d809400de44765941f3f065549b22439a356fcd9476302575d166f42a; editorial review pending	imf lang::en chapter::022 module::022-01 review::pending