Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the most likely reason for the elevated fasting plasma glucose in a patient with type 2 diabetes and suspected tooth infection?

1. Hyperthyroidism

2. Secondary glipizide failure

3. Secondary infection of tooth

4. Progressive beta-cell destruction

The correct answer is: Secondary infection of tooth

In patients with type 2 diabetes, elevated fasting plasma glucose levels can occur due to various physiological responses, especially in the presence of an infection. When a person has an active infection, such as a tooth infection, the body releases inflammatory cytokines as part of the immune response. These cytokines can lead to insulin resistance, making it more difficult for the body to utilize glucose effectively. Consequently, glucose production in the liver may increase while glucose uptake in muscle and fat tissues decreases, resulting in elevated fasting plasma glucose levels. The context of an ongoing infection is significant; it amplifies the stress on the body and influences blood glucose regulation. In the case of a tooth infection, pain, swelling, and systemic inflammatory responses can further contribute to elevated glucose levels, demonstrating how infections can also temporally complicate diabetes management. The other choices do not directly relate to the acute elevation of fasting plasma glucose in the context of an observed infection. Hyperthyroidism would cause elevated blood glucose but is not specifically tied to dental infections. Secondary glipizide failure pertains to challenges with medication efficacy rather than acute physiological changes due to infection. Lastly, while progressive beta-cell destruction is a component of the chronic progression of type 2 diabetes, it usually does not precipitate