Which of the following are complications of diabetes? (Select all that apply)

Choice A reason: Beta blockers are used in cirrhosis to reduce portal hypertension and variceal bleeding risk but are not a priority in acute liver failure. They do not address immediate life-threatening issues like hemodynamic instability or respiratory compromise, which are critical in acute liver failure management.

Choice B reason: Maintaining airway and stabilizing circulation is the priority in acute liver failure, as patients may develop cerebral edema, causing respiratory compromise, or coagulopathy, leading to bleeding and shock. Ensuring oxygenation and hemodynamic stability prevents multi-organ failure, addressing the most immediate life-threatening complications of liver failure.

Choice C reason: Paracentesis removes ascitic fluid in cirrhosis but is not a priority in acute liver failure, where ascites is less prominent. It does not address urgent issues like airway compromise or circulatory shock, which are critical in preventing rapid deterioration in acute liver failure.

Choice D reason: Vitamin K corrects coagulopathy from liver dysfunction but is not the priority in acute liver failure. While bleeding risk is significant, airway and circulatory stability take precedence, as respiratory failure or shock are more immediately life-threatening than correctable coagulopathy in this acute setting.

Choice A reason: Metformin reduces blood sugar primarily by inhibiting hepatic gluconeogenesis, decreasing liver glucose production. It also enhances insulin sensitivity in peripheral tissues, reducing hyperglycemia in type 2 diabetes without causing hypoglycemia, as it does not stimulate insulin secretion, making this the accurate mechanism.

Choice B reason: Metformin does not block carbohydrate absorption in the intestine. Drugs like alpha-glucosidase inhibitors (e.g., acarbose) slow carbohydrate breakdown, but metformin primarily acts on the liver to reduce gluconeogenesis and improve insulin sensitivity, not directly affecting intestinal absorption.

Choice C reason: Metformin does not stimulate insulin release from the pancreas. This is the mechanism of sulfonylureas, which enhance beta-cell insulin secretion. Metformin works by reducing hepatic glucose output and increasing insulin sensitivity, making this statement incorrect for its mechanism of action.

Choice D reason: Metformin decreases, not increases, insulin resistance. It enhances insulin sensitivity in muscle and liver cells, improving glucose uptake and utilization. Increasing insulin resistance would worsen type 2 diabetes, making this statement incorrect, as metformin’s goal is to counteract insulin resistance.