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IMF-022-02-0001-en	How do lactate, alanine and glycerol supply gluconeogenesis during fasting?	Lactate returns to the liver through the Cori cycle, alanine carries carbon and nitrogen from muscle, and glycerol from lipolysis enters gluconeogenesis.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0002-en	How does exercise improve muscle glucose handling acutely compared with over time?	Acutely it increases insulin-independent muscle glucose uptake; over time it improves insulin sensitivity, supporting metabolic flexibility.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0003-en	Why do incretin-based therapies carry relatively low intrinsic hypoglycaemia risk, and when is this lost?	Incretins amplify insulin only when glucose is present, so the risk stays low unless they are combined with insulin or secretagogues.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0004-en	How does glucose toxicity turn type two diabetes into a self-reinforcing cycle?	Once secretion cannot match resistance, hyperglycaemia itself further worsens both insulin secretion and sensitivity, raising glucose again.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0005-en	How do iron deficiency and haemolysis push glycated haemoglobin in different directions?	Red-cell survival changes glycated haemoglobin: iron deficiency may raise it, while haemolysis, blood loss or recent transfusion can lower or distort it.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0006-en	Why should a continuous sensor reading be confirmed when it conflicts with symptoms?	Sensors measure interstitial glucose, which lags behind blood glucose during rapid change.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0007-en	Why does repeated correction insulin without identifying the pattern cause harm?	Correction insulin cannot replace an inadequate basal or meal strategy, so repeated correction creates oscillation and hypoglycaemia.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0008-en	Why does interruption of an insulin pump cause rapid insulin deficiency?	No long-acting insulin depot remains, so stopping delivery leaves nothing to sustain insulin action.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0009-en	Why can measured sodium be low in ketoacidosis even though total body sodium is depleted?	Hyperglycaemia draws water into the extracellular space, diluting sodium, while osmotic diuresis and vomiting deplete total body sodium.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0010-en	Why must a near-normal glucose not exclude ketoacidosis?	Euglycaemic ketoacidosis occurs with reduced carbohydrate intake, pregnancy, prolonged fasting, partial insulin treatment and sodium-glucose cotransporter inhibition, so ketones and acidosis decide.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0011-en	Why is insulin often delayed in hyperosmolar hyperglycaemic state, and why must tonicity fall in a controlled way?	Fluids alone lower glucose and improve perfusion; rapid water entry into the adapted brain can be harmful, so tonicity is lowered in a controlled way.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0012-en	When may glucagon be less effective for severe hypoglycaemia?	With depleted glycogen, alcohol, liver disease or prolonged fasting, so parenteral glucose and airway protection remain central in severe episodes.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0013-en	How does adipose expansion beyond its capacity lead to insulin resistance in other organs?	Hypertrophic adipocytes release more fatty acids and inflammatory signals, and lipid accumulates in liver, muscle and pancreas, interfering with insulin signalling.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending
IMF-022-02-0014-en	Why do protein intake and resistance exercise matter during weight reduction, especially in older or frail patients?	Loss of muscle during weight reduction reduces function and metabolic capacity, so adequate protein, resistance exercise and gradual monitoring protect it.	Integrated Medical Foundations; chapter 22, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fb0e6cc1a6c106fbc41b8d9bf04c2ed381bfb66eeb451924d749aa6624ce8b5; editorial review pending	imf lang::en chapter::022 module::022-02 review::pending