[Solved] T2DM

T2DM is characterized by insulin resistance or defective B-cell insulin secretion. Please DISCUSS two possible mechanisms of insulin resistance in T2DM.

  2. INTRODUCE your topic. When writing an exam topic, one should begin with a brief introduction and after that, soar as high as possible, adding all the detail, depth and breadth (DDB) that are expected from a graduate essay.

         [Story:  My PhD advisor was an old German professor (36 years old at the time, but a very old soul) once told me that graduate students tended to write in a very convoluted manner as a way to demonstrate their knowledge.  His suggestions: a) start your writings with a basic introduction to grab the readers’ attention and interest; b) after that, you can climb as high as desired.  I never forgot that piece of advice and used it very often in my lectures and writings.] 

  1. USE all your allotted space. Use all your allotted space. One cannot write an exam to the DDB that I expect in less than one full page.

[Story: When I taught this course on a face-to-face format, and students turned in their exams to my desk at the front of the room, I began to notice that some had written extensively, using up all the allotted space, while others wrote one-half or even one-third of a page. After many years of experience, I had noticed that those who wrote short exams invariably did not cover the material to the necessary detail, depth, and breadth expected in a graduate project.  I then started an experiment: I began separating the “one-pagers” from the “less-than-one-pagers” in two piles at the time they were delivered to my desk.  After I graded them (blinded, I should add), sure enough, all the good grades came from the “one-pager” pile, and those who failed the exams were in the “less-than-one-pager” pile.] 

  1. HOW much detail? When questioning whether to be more or less detailed in answering a question, it is better to err on the “more” than the “less” side. In a graduate paper I expect depth and breadth, with a lot of detail and relevant information.  This does not mean that one should write “treatises” on the topic being asked, but whatever is discussed needs to be a thorough presentation of the findings. Elements of one’s search — questioning, discussion, and conclusions — as in any scientific paper need to be addressed in depth. Please refer to the “good exam” example posted in the course syllabus to have an idea of what I mean by detail, depth and breadth.

         exams should be written using APA FORMAT, except for the following
a.  Do not use a title page.
b.  Do not double space your text.
c.  There is no need to measure your margins.

On top of the first page, write the course number and your name. Following that, identify clearly the question you are answering (E.g., QA1) and start your answer.

  2. “Quotes,” “Quotes,” “Quotes.”  DO NOT USE THEM !
    I much prefer to read an answer paraphrased from the source, than to see statement after statement in quotes that were lifted verbatim from the consulted sources.  A text that has a lot of sentences in quotes indicates to me that the writer only cut and pasted the information, many times in a manner that lacks logic and continuity, signifying a possible absence of real knowledge. In other words, there was no personal creativity, just proficiency with “electronic scissors.” In addition to that, it reads choppy and fractured.

[Story:  A colleague of mine once said that whenever she writes a paper, she consults all the information sources and takes copious notes, then shuts down all those publications, puts them aside, and paraphrases the newly acquired knowledge in her own words (citing the sources, of course).  This way, she says, “she will never be accused of plagiarism.”  Grand idea ! ! ! ]

  1. Colloquialisms.  DO NOT USE THEM !
    One should avoid the use of colloquialisms.  Statements like “The immune system acts like a pack of wild dogs attacking an elk . . .” or “Meanwhile, back in the nucleus . . .” (all of which I have encountered in essay exams) may look good in a romance novel, but not in a scientific article.
  2. Personal pronouns (I, your, me mine, etc.).  DO NOT USE THEM !
    The writer should avoid the use of personal pronouns in scientific writing.  Whenever I read:  “. . . and this is what happens to your immune system. . .” I feel compelled to comment:  “Whose immune system are you talking about?  What do you know about MY immune system?”
  4. Number of references.

    In High School one may have been given a minimum number of sources to consult. As we have long moved beyond that, you are expected to consult multiple sources of information, a minimum of 4 sources per question, not including the textbook.  The textbook is a good starting point, but in answering your questions, I expect you to go WAY beyond the textbook in your search for sources of information.
  5. Currency of the sources of information consulted.

References must be recent, within the 21st Century.

  1. Quality of sources consulted.
    Please do not use textbooks form other nursing disciplines (Pharmacology, Critical Care Nursing, etc.), since ours is a PATHOPHYSIOLOGY course, and references obtained from a patho text are much more complete and better suitable to your exam.
    One should NEVER, EVER, EVER, EVER, cite from a dictionary or encyclopedia:  “According to Taber, oxygen diffuses downwards a concentration gradient from alveolar air to venous blood . . .” Note: Mr. Taber or the authors of entries in Wikipedia or Encarta did NOT reach the scientific conclusions on their own.  They simply gathered and organized data.  Consulting encyclopedias is OK for High School term papers, but it is not acceptable for a graduate exam.
    Undergraduate texts (such as Copstead & Banasik; Porth; Price & Wilson; Huether & McCance; Bullock & Henze; Burns; Crowley; Crutchlow;  Hansen; Hogan) will not provide enough in depth information for use in a graduate exam.  I provided you in the syllabus with a (partial) list of undergraduate texts that should not be used.
    Stay away from generic information (e.g., Merck Manual), and sources aimed at patient education, or for public information (American Cancer Society: “All you need to know about cancer”, for example) as they are written for a non-technical audience, or at much lower level than would be expected here.
    Information obtained from the web should be carefully screened. There is a lot of junk out there.  Stick to reliable sources such as The New England Journal of Medicine, JAMA, Heart & Lung, Critical Care Nursing Journal, etc.

When doing Google searches (which I thoroughly recommend and do all the time), be sure to select “Google Scholar” to reach the best and most reliable scholar publications.

  1. How to reference your sources.

    Every statement, beyond the obvious (“Water molecules consist of 2 atoms of hydrogen and 1 atom of oxygen”), should be referenced, both in the body of the text, and in the bibliography list. APA FORMAT must be used both in citing sources in the text, as well as listing consulted references in the bibliography list that shall be placed at the end of each answer.





  1. Make sure your exam complies with all the instructions above.
  2. Feel free to contact me if you have any exceptions to the instructions above (before submitting your paper, of course).
  3. Run your exam through a spell-check program. Typos are bad form in graduate work and scientific writing in general.
  4. Save your exam as one Microsoft Word file. That file should be named: 5333-midterm or 5333-final, as it applies (that’s all; no names here, no BIOL prefix, etc). DO NOT submit individual answers as separate files.  If so, your exam will be returned to you for correction.
  5. Attach you exam (in the final MS Word file format) to an e-mail addressed to me (mdacunha@twu.edu), and label your e-mail message 5333-midterm, or 5333-final (as it applies) on the e-mail title (or subject) line.
  6. Submit your exam within the designated time schedule. It is wise not to wait for the last minute, as unpredictable situations may occur (e.g., loss of Internet connections on your end or mine, missing exam portions, BlackBoard blackouts, etc.) that will prevent you from adhering to the deadlines. Exams e-mailed after the deadline will NOT be accepted by the instructor.
  7. Your exams will be returned electronically to you with my comments and grades. Your answers will be graded according to the following criteria:
  • How thorough are your answers:  Do they express the detail, depth, breadth of your research, as expected in a graduate course??
  • How appropriate are your answers:  Do they address all the parts of each question?  Do they represent the detail, depth, breadth, expected in a graduate course?
  • How appropriately you utilized and cited the sources consulted, both in the text and in the reference list:  Are they relevant to the text/topic?  Are they recent?  Are they presented as instructed above (location, APA format, etc.)?  Were texts from other disciplines used?  (DON’T !)  Were undergraduate texts cited?  (DON’T !)  Were sources of information directed at patients and general public used? (DON’T !)

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