Endocrine Pharmacology: Blood Glucose and Insulin

Questions and Answers

What is the primary mechanism of action by which insulin decreases potassium levels in the body?

Insulin decreases the absorption of potassium from the gut

Insulin stimulates the uptake of potassium by muscles and liver cells (correct)

Insulin inhibits the release of aldosterone, leading to decreased potassium levels

Insulin increases the excretion of potassium by the kidneys

Why is it necessary to co-administer glucose when using IV insulin to treat hyperkalemia?

To increase the absorption of insulin

To potentiate the effect of insulin on potassium levels

To enhance the excretion of potassium by the kidneys

To prevent hypoglycemia (correct)

Which type of insulin has a cloudy appearance due to the presence of protamine?

Lispro insulin

Regular insulin

NPH insulin (correct)

Glargine insulin

What is the primary reason why insulin cannot be administered orally?

Insulin is degraded by digestive enzymes in the gut Signup and view all the answers

What is the concentration of U-100 insulin?

100 units of insulin per mL Signup and view all the answers

What is the primary reason why Glargine (Lantus) insulin should not be frozen?

Freezing causes degradation of the insulin protein Signup and view all the answers

Which type of insulin is typically used in insulin pumps?

Lispro insulin Signup and view all the answers

What is the primary guideline for healthcare professionals when prescribing medications to the elderly?

Start with a low dose and titrate up as needed Signup and view all the answers

What is the purpose of sliding scale insulin?

To reactively correct blood glucose levels Signup and view all the answers

Which of the following insulin types is contraindicated in patients with renal impairment?

Thiazolidenediones Signup and view all the answers

What is the mechanism of action of sulfonylureas?

Increase insulin secretion Signup and view all the answers

What is the suffix for Meglitinides?

-glide Signup and view all the answers

What is the main difference between Humulin R and Humulin N?

Duration of action Signup and view all the answers

What is the primary effect of SGLT2 inhibitors?

Decrease glucose reabsorption in the kidneys Signup and view all the answers

What is the primary mechanism of action of GLP-1 agonists?

Slow gastric emptying Signup and view all the answers

What is the primary side effect of DPP-4 inhibitors?

Nasopharyngitis Signup and view all the answers

What is the main difference between GLP-1 agonists and DPP-4 inhibitors?

Mechanism of action Signup and view all the answers

Which of the following medications is often used when diabetes treatment has been ineffective?

Insulin Signup and view all the answers

What is the mechanism of action of Metiglinides?

Binding to an allosteric site on the potassium channel, resulting in a conformational change Signup and view all the answers

What is the normal function of the SGLT2 receptor in the proximal convoluted tubules?

To reabsorb sodium and glucose together Signup and view all the answers

What is the effect of GLP-1 on gastric emptying?

It decreases gastric emptying Signup and view all the answers

What is the effect of DPP-4 inhibitors on glucagon release?

They inhibit glucagon release Signup and view all the answers

What is the threshold for glucose excretion in the urine?

200mg/dL Signup and view all the answers

What is a common side effect of SGLT2 inhibitors?

Vaginal yeast infection Signup and view all the answers

What is the mechanism of action of GLP-1 receptor agonists?

Mimicking the action of GLP-1, promoting insulin release and inhibiting glucagon release Signup and view all the answers

What is a rare but serious side effect of SGLT2 inhibitors?

Fournier's gangrene Signup and view all the answers

What is the result of rapid drops in potassium levels?

Hypokalemia Signup and view all the answers

What is the effect of insulin on the sodium potassium pump?

Increases the activity of the pump, moving sodium out of the cells and potassium into the cells Signup and view all the answers

What is the purpose of mixing clear and cloudy insulin?

To create a combination of short and intermediate acting insulin Signup and view all the answers

What is the concentration of insulin denoted by '100 units/mL'?

There are 100 units of insulin per mL of solution Signup and view all the answers

What is the normal range of blood glucose levels?

80 mg/dL Signup and view all the answers

What is the purpose of sliding scale insulin?

To address hyperglycemia after it occurs Signup and view all the answers

What is the action of metformin?

Reduces liver ability to undergo gluconeogenesis, increases cell insulin receptor sensitivity to insulin, and reduces glucose absorption in the GI tract Signup and view all the answers

What is the action of pioglitazone?

Lowers glucose production in the liver, alters gene transcription involved in glucose metabolism, and helps muscle and adipose tissues use glucose Signup and view all the answers

What is the common side effect of sulfonylureas?

Hypoglycemia and weight gain Signup and view all the answers

What is the mechanism of action of glitazones?

Turn on genes that increase the sensitivity of cells to insulin, improving glucose uptake and utilization Signup and view all the answers

What is the typical range of hemoglobin A1C for a diabetic patient?

7-8% Signup and view all the answers

Which type of insulin is often used in critical care settings due to its rapid onset and short duration of action?

Regular insulin Signup and view all the answers

What is the primary reason why insulin cannot be administered orally?

It is broken down by digestive enzymes Signup and view all the answers

What is the typical action taken when a patient's glucose level is greater than 400?

All of the above Signup and view all the answers

What is the primary reason why potassium levels should be monitored when administering IV insulin?

IV insulin can cause hypokalemia Signup and view all the answers

What is the typical concentration of U-100 insulin?

100 units/mL Signup and view all the answers

What is the primary reason why NPH insulin cannot be mixed with other insulin types?

It has a different pH level Signup and view all the answers

What is the primary guideline for healthcare professionals when prescribing medications to the elderly?

Start with low doses and titrate up Signup and view all the answers

What is the primary mechanism of action of thiazolidenediones?

Activate the PPAR-gamma receptor Signup and view all the answers

Which of the following insulin types is associated with the highest risk of hypoglycemia?

Lispro Signup and view all the answers

What is the primary mechanism of action of sodium-glucose cotransporter 2 (SGLT2) inhibitors?

Inhibit the reabsorption of glucose in the kidneys Signup and view all the answers

Which of the following medications is contraindicated in patients with renal impairment?

Metformin Signup and view all the answers

What is the primary mechanism of action of glucagon-like peptide-1 (GLP-1) agonists?

Stimulate the release of insulin Signup and view all the answers

What is the primary side effect of dipeptidyl peptidase-4 (DPP-4) inhibitors?

Nasopharyngitis Signup and view all the answers

What is the primary mechanism of action of sulfonylureas?

Increase the release of insulin Signup and view all the answers

Which of the following medications is associated with a higher risk of cardiovascular events?

Thiazolidenediones Signup and view all the answers

What is the primary mechanism of action of meglitinides?

Increase the release of insulin Signup and view all the answers

Which of the following medications is often used when diabetes treatment has been ineffective?

Insulin Signup and view all the answers

What is the primary reason for rapid drops in potassium levels when using insulin?

Increased activity of the sodium potassium pump Signup and view all the answers

What is the purpose of administering glucose with IV insulin to treat hyperkalemia?

To prevent hypoglycemia Signup and view all the answers

What is the primary difference between Humulin R and Humulin N?

Humulin R is short-acting, while Humulin N is long-acting Signup and view all the answers

What is the primary mechanism of action of Amylin mimetics?

Inhibit the release of glucagon from the pancreas Signup and view all the answers

What is the primary side effect of sulfonylureas?

All of the above Signup and view all the answers

What is the purpose of Beers criteria?

To guide medication prescribing in the elderly Signup and view all the answers

What is the primary mechanism of action of glitazones?

Increase the sensitivity of cells to insulin Signup and view all the answers

What is the primary effect of SGLT2 inhibitors?

Increase the excretion of glucose in the urine Signup and view all the answers

What is the primary mechanism of action of metformin?

Reduce the production of glucose in the liver Signup and view all the answers

What is the primary reason for storing insulin in the refrigerator?

To prevent the degradation of the insulin Signup and view all the answers

What is the effect of blocking potassium channels on insulin release?

Increased potassium levels, leading to depolarization and increased insulin release Signup and view all the answers

What is the primary mechanism of action of SGLT2 inhibitors?

Inhibiting the reabsorption of sodium and glucose in the proximal convoluted tubules Signup and view all the answers

What is the effect of GLP-1 on gastric emptying?

Decreases gastric emptying, leading to slower glucose absorption Signup and view all the answers

What is the primary side effect of SGLT2 inhibitors?

UTI Signup and view all the answers

What is the mechanism of action of DPP-4 inhibitors?

Inhibiting the breakdown of incretin, leading to increased insulin release Signup and view all the answers

What is the primary difference between GLP-1 agonists and DPP-4 inhibitors?

MOA, GLP-1 agonists stimulate insulin release directly, while DPP-4 inhibitors inhibit the breakdown of incretin Signup and view all the answers

What is the threshold for glucose excretion in the urine?

200mg/dL Signup and view all the answers

What is a rare but serious side effect of SGLT2 inhibitors?

Fournier’s gangrene Signup and view all the answers

Study Notes

Endocrine Pharmacology

Blood Glucose Levels

Normal hemoglobin A1C: < 5.6%
Prediabetic hemoglobin A1C: 5.7-6.4%
Diabetic A1C: 6.5% and above
Normal fasting blood glucose: 80-100 mg/dL
Prediabetic fasting blood glucose: 100-125 mg/dL
Diabetic fasting blood glucose: 126 mg/dL and above

Insulin

A1C aim for diabetics: < 7.0%
Short-duration/fast-acting insulin: Lispro, Aspart, Glulisine
Insulin and glucagon are released from beta cells and alpha cells of the pancreas, respectively
Glucagon is used in emergency situations to treat severe hypoglycemia
Insulin cannot be taken orally due to enzymatic degradation
Long-duration insulin: Glargine, Detemir
NPH insulin: intermediate-acting, cloudy appearance
Regular insulin: can be given both subQ and IV
IV insulin is used to treat diabetic ketoacidosis and perioperative care

Potassium Levels and Insulin

When insulin is administered, potassium levels may drop due to increased cellular uptake
Normal potassium levels: 3.5-5.2 mEq/L
Insulin increases the activity of the sodium-potassium pump, leading to decreased potassium levels

Insulin Administration

Rapid-acting insulin: Lispro, Aspart, Glulisine (used in insulin pumps)
Sliding scale insulin: used as a dosing guide for insulin, addressing hyperglycemia after it occurs
Common sites for insulin administration: abdomen, back, thighs, love handles, etc.

Other Diabetes Medications

Metformin: biguanide, reduces liver glucose production, increases insulin receptor sensitivity
Thiazolidinediones: suffix -glitazone, lowers glucose production in the liver, alters gene transcription
Sulfonylureas: suffix -ide, promote insulin release from the beta cells of the pancreas
Meglitinides: suffix -glinide, binds to an allosteric site on the potassium channel, increasing insulin release
SGLT2 inhibitors: suffix -Flozin, blocks glucose reabsorption in the proximal convoluted tubules, leading to increased glucose excretion in the urine
GLP-1 agonists: suffix -tide, natural substance released after carb ingestion, promotes insulin release and inhibits glucagon release
DPP-4 inhibitors: suffix -gliptin, inhibits the breakdown of incretin, leading to increased insulin release and decreased blood sugar levels

Endocrine Pharmacology

Blood Glucose Levels

Normal hemoglobin A1C: < 5.6%
Prediabetic hemoglobin A1C: 5.7-6.4%
Diabetic A1C: 6.5% and above
Normal fasting blood glucose: 80-100 mg/dL
Prediabetic fasting blood glucose: 100-125 mg/dL
Diabetic fasting blood glucose: 126 mg/dL and above

Insulin

A1C aim for diabetics: < 7.0%
Short-duration/fast-acting insulin: Lispro, Aspart, Glulisine
Insulin and glucagon are released from beta cells and alpha cells of the pancreas, respectively
Glucagon is used in emergency situations to treat severe hypoglycemia
Insulin cannot be taken orally due to enzymatic degradation
Long-duration insulin: Glargine, Detemir
NPH insulin: intermediate-acting, cloudy appearance
Regular insulin: can be given both subQ and IV
IV insulin is used to treat diabetic ketoacidosis and perioperative care

Potassium Levels and Insulin

When insulin is administered, potassium levels may drop due to increased cellular uptake
Normal potassium levels: 3.5-5.2 mEq/L
Insulin increases the activity of the sodium-potassium pump, leading to decreased potassium levels

Insulin Administration

Rapid-acting insulin: Lispro, Aspart, Glulisine (used in insulin pumps)
Sliding scale insulin: used as a dosing guide for insulin, addressing hyperglycemia after it occurs
Common sites for insulin administration: abdomen, back, thighs, love handles, etc.

Other Diabetes Medications

Metformin: biguanide, reduces liver glucose production, increases insulin receptor sensitivity
Thiazolidinediones: suffix -glitazone, lowers glucose production in the liver, alters gene transcription
Sulfonylureas: suffix -ide, promote insulin release from the beta cells of the pancreas
Meglitinides: suffix -glinide, binds to an allosteric site on the potassium channel, increasing insulin release
SGLT2 inhibitors: suffix -Flozin, blocks glucose reabsorption in the proximal convoluted tubules, leading to increased glucose excretion in the urine
GLP-1 agonists: suffix -tide, natural substance released after carb ingestion, promotes insulin release and inhibits glucagon release
DPP-4 inhibitors: suffix -gliptin, inhibits the breakdown of incretin, leading to increased insulin release and decreased blood sugar levels

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Description

This quiz covers the normal and abnormal levels of blood glucose, hemoglobin A1C, and the types of insulin used to manage diabetic conditions.