Which type of diabetes is frequently associated with obesity and aging and may or may not require insulin therapy?

Choice A rationale: Hypothyroidism, or an underactive thyroid gland, in infants is often congenital and characterized by insufficient thyroid hormone production. Thyroid hormones are crucial for metabolic rate regulation and neurologic development. Insufficient levels lead to a slowed metabolism, causing symptoms like lethargy and excessive sleep. Snoring can be a sign of macroglossia, or an enlarged tongue, which is also associated with congenital hypothyroidism.
Choice B rationale: Hyperthyroidism, or an overactive thyroid gland, is characterized by the overproduction of thyroid hormones, leading to an increased metabolic rate. This condition would manifest in an infant with symptoms that are the opposite of those described, such as irritability, sleeplessness, and an increased appetite, not lethargy or excessive sleep. These symptoms reflect a hypermetabolic state.
Choice C rationale: Type 2 diabetes mellitus is a metabolic disorder characterized by insulin resistance and hyperglycemia. While it can cause lethargy and excessive sleepiness, it is extremely rare in infants and is not associated with snoring or an enlarged tongue. The primary symptoms in this age group are more likely to be related to fluid balance and glucose control.
Choice D rationale: Tay-Sachs disease is a rare, fatal, neurodegenerative genetic disorder. It results from the absence of a vital enzyme, hexosaminidase A, which leads to the buildup of gangliosides in the brain. Symptoms typically appear around 6 months of age and include a startle response, loss of motor skills, and an exaggerated response to noise, not lethargy or snoring.

Choice A rationale: Hyperglycemia results from a lack of insulin, leading to an inability of cells to uptake glucose. Glucagon functions as a hormone that stimulates the liver to convert stored glycogen into glucose, thereby raising blood glucose levels. Administering glucagon in an already hyperglycemic state would exacerbate the condition, potentially leading to a dangerous spike in blood sugar. It's used for low, not high, blood sugar.
Choice B rationale: Hypoglycemia, a dangerously low blood glucose level (typically below 70 mg/dL), can be caused by an overdose of insulin, which drives too much glucose into cells. Glucagon is a hormone that counteracts insulin's effects by stimulating glycogenolysis in the liver, releasing stored glucose into the bloodstream. This rapid increase in circulating glucose effectively treats the acute hypoglycemic episode, making it an essential emergency treatment.
Choice C rationale: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. It is caused by an absolute or relative lack of insulin. Administering glucagon would increase blood glucose levels even further, worsening the hyperglycemia, which is a primary component of DKA. Insulin and fluid replacement are the mainstays of treatment for DKA.
Choice D rationale: Hyperglycemia during 'sick days' is a common phenomenon in people with diabetes due to increased stress hormones like cortisol and epinephrine, which raise blood glucose. Administering glucagon would further elevate blood sugar, intensifying the existing hyperglycemia. Therefore, glucagon is contraindicated in this scenario, as it would worsen the metabolic state rather than improving it.