Insulin and Diabetes Regulation Quiz

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Questions and Answers

What role does insulin have in glucose metabolism?

Stimulates the breakdown of glycogen

Facilitates the transport of glucose into cells (correct)

Inhibits the uptake of fatty acids

Increases glucose production in the liver

What is a major factor in the development of type 1 diabetes mellitus?

Hormonal fluctuations from adrenal insufficiency

Increased glucagon secretion

Destruction of pancreatic beta cells (correct)

Excessive insulin production due to obesity

What is the function of glucagon in blood glucose regulation?

Promotes liver storage of glucose as glycogen

Encourages the release of stored glucose from the liver (correct)

Inhibits the conversion of glucose to fat

Stimulates muscle cells to uptake more glucose

Which process does insulin stimulate in adipose tissue?

Storage of dietary fat Signup and view all the answers

Which of the following is associated with Cushing’s syndrome?

Hyperglycaemia due to high cortisol Signup and view all the answers

What is a primary consequence of the destruction of beta cells?

Decreased insulin production Signup and view all the answers

What triggers the release of insulin in normal physiology?

Increase in blood glucose levels post meal Signup and view all the answers

Which condition is associated with high levels of glucose in the blood after meals?

Post prandial hyperglycaemia Signup and view all the answers

What occurs when the renal threshold for glucose is exceeded?

Glycosuria and osmotic diuresis Signup and view all the answers

What is the effect of basal insulin during fasting periods?

Releases small amounts of insulin continuously Signup and view all the answers

What autoimmune response is commonly observed in type 1 diabetes?

Production of antibodies against insulin Signup and view all the answers

What characterizes insulin resistance in type 2 diabetes?

Diminished intracellular reactions to insulin Signup and view all the answers

What happens when beta cells cannot meet the insulin demand in type 2 diabetes?

Glucose levels rise in the blood Signup and view all the answers

What is the main action of Alpha Glucosidase Inhibitors?

Slow the absorption of glucose Signup and view all the answers

What is the common outcome when uncontrolled type 2 diabetes occurs?

Hyperglycemic hyperosmolar non-ketotic syndrome Signup and view all the answers

Which medication is categorized as a D-phenylalanine derivative?

Nateglinide Signup and view all the answers

Why does diabetic ketoacidosis not typically occur in type 2 diabetes?

There is enough insulin to inhibit fat breakdown Signup and view all the answers

What factor is thought to contribute to insulin resistance in type 2 diabetes?

Genetic factors Signup and view all the answers

Which type of insulin is characterized as clear and has a rapid onset of action?

Rapid-acting insulin Signup and view all the answers

What is a potential indication for using insulin in type 2 diabetes?

During periods of stress like surgery Signup and view all the answers

Which of the following medications enhances insulin action at receptor sites?

Pioglitazone Signup and view all the answers

What characterizes Long-acting insulin?

It has a prolonged effective duration Signup and view all the answers

Sitagliptin (Januvia) functions primarily by increasing what in the body?

Incretin levels Signup and view all the answers

Which combination therapy involves NPH and regular insulin?

Both A and B Signup and view all the answers

What is the appropriate glucose level for a 2-hour postload glucose during an oral glucose tolerance test to indicate potential diabetes?

200 mg/dL (11.1 mmol/L) Signup and view all the answers

Which component is NOT part of diabetic management as described?

Regular sleep patterns Signup and view all the answers

Why can sulfonylureas not be used for patients with type 1 diabetes?

A functioning pancreas is necessary. Signup and view all the answers

What is the primary action of biguanides in treating diabetes?

Facilitating insulin's action on peripheral receptor sites. Signup and view all the answers

When should sulfonylureas be administered for optimal effect?

With meals Signup and view all the answers

Which of the following medications can be used to enhance glucose-lowering effects when used with biguanides?

Sulfonylureas Signup and view all the answers

What is a primary therapeutic goal in diabetes management?

Normal blood glucose levels without hypoglycemia Signup and view all the answers

Which of the following factors can lead to changes in diabetes treatment plans?

Advances in treatment methods Signup and view all the answers

What is a characteristic feature of diabetes mellitus?

Elevated level of glucose in the blood Signup and view all the answers

Which type of diabetes is primarily diagnosed in younger individuals?

Type 1 Diabetes Mellitus Signup and view all the answers

Which factor is NOT commonly associated with type 2 diabetes?

Genetic mutation Signup and view all the answers

What percentage of the population is affected by type 1 diabetes?

About 5% to 10% Signup and view all the answers

Gestational diabetes occurs during which period?

Second half of pregnancy Signup and view all the answers

Which group is most likely to be undiagnosed in diabetes mellitus statistics?

Patients older than 65 years Signup and view all the answers

What is the percentage of pregnant women who may develop gestational diabetes?

Approximately 14% Signup and view all the answers

What is a common risk factor for developing gestational diabetes?

Obesity Signup and view all the answers

Which of the following is a risk factor for developing type 2 diabetes mellitus?

Having a family history of diabetes Signup and view all the answers

What is the minimum fasting plasma glucose level that indicates potential diabetes?

126 mg/dL Signup and view all the answers

Which of the following symptoms is NOT commonly associated with diabetes mellitus?

Excessive sweating Signup and view all the answers

An individual is diagnosed with diabetes if they have classic symptoms plus which random plasma glucose concentration?

200 mg/dL Signup and view all the answers

Which test provides an average of blood glucose levels over the previous three months?

HbA1c Signup and view all the answers

Which condition is characterized by hyperglycemia and results in the body using fat and protein for energy?

Type 1 diabetes mellitus Signup and view all the answers

What level of HDL cholesterol is considered a risk factor for type 2 diabetes mellitus?

Below 35 mg/dL Signup and view all the answers

Which of the following factors refers to a history that can increase the risk of developing type 2 diabetes?

Pregnancy complications Signup and view all the answers

Study Notes

Diabetes Mellitus

Diabetes mellitus (DM) is a group of metabolic diseases characterized by high blood glucose levels. This results from defects in insulin secretion, insulin action, or both.
DM is also a chronic systemic disease, characterized by either a deficiency of insulin or a decreased ability of the body to use insulin. It's often referred to as "high sugars."
As of 1995, there were 135 million DM patients worldwide. In 2010, this rose to 285 million and 366 million in 2011. The global estimate is expected to reach 552 million by 2030, with 80% of these cases in low and middle-income countries.
A significant portion (up to 50%) of DM patients are over 65 years old. Approximately 183 million (50%) of those with diabetes remain undiagnosed, and 4.6 million deaths globally were associated with DM in 2011.
Data from 2011 indicates that Diabetes Mellitus deaths in Ghana reached 2,752, accounting for 1.47% of the total deaths.
The global increase in DM cases is attributed to an aging population and a rise in unhealthy lifestyles, poor dietary practices, and decreased physical activity.

Classification

There are four major classifications of DM:
- Type 1 (Juvenile or Insulin Dependent Diabetes Mellitus): Affects 5-10% of people, typically diagnosed before age 30, and requiring daily insulin treatment. Causes include genetic, immunologic, and environmental factors.
- Type 2 (Non-Insulin Dependent Diabetes Mellitus): Affects 90-95% of people, usually diagnosed after age 40, and often associated with certain ethnic and racial groups; also sometimes referred to as stable diabetes. Causes include heredity, obesity, and environmental factors.
- Gestational Diabetes Mellitus (GDM): Develops in up to 14% of pregnant women, increasing their risk for hypertensive problems. Occurs primarily in the second half of pregnancy, potentially leading to larger babies. Women with a family history of DM and obesity are at a higher risk.
- DM associated with other conditions: This type is linked to certain medications (like oral contraceptives and corticosteroids) and hormonal conditions (such as adrenal insufficiency or Cushing's Syndrome). This accounts for 1-2% of diagnosed cases.

Pathophysiology

In healthy individuals, insulin, secreted by beta cells in the pancreas, increases after meals. It facilitates the transfer of glucose from the bloodstream into muscle, liver, and fat cells.
Insulin's function in these cells is to: metabolize glucose for energy, stimulate glucose storage as glycogen in the liver and muscles, and signal the liver to stop glucose release, enhance dietary fat storage, and accelerate amino acid transport from dietary proteins into cells. Insulin also inhibits the breakdown of stored glucose, protein, and fat.
Between meals (fasting periods) or overnight the pancreas continues releasing small amounts of insulin (basal insulin).
During low blood glucose levels, glucagon, another pancreatic hormone (secreted by alpha cells), is secreted to stimulate the liver to release stored glucose.
In Type 1 DM, there's destruction of pancreatic beta cells, leading to an absolute deficiency of insulin. This could be due to genetic, immunologic, or environmental (e.g., viral) factors, though the exact process of destruction isn't fully understood. People with particular Human Leukocyte Antigen (HLA) types are known to be genetically predisposed. Also, evidence shows that autoimmune responses, where antibodies target the body's normal tissues as if they were foreign, can play a role in destruction. Environmental factors like viruses or toxins have been considered as initiating factors of beta cell destruction. All these result in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Glucose from food then remains in the blood after a meal, contributing to post-prandial hyperglycemia.
In Type 2 DM, the primary issues are insulin resistance and impaired insulin secretion. Insulin resistance is characterized by a decreased sensitivity to insulin. Normal insulin receptors initiate intracellular glucose metabolic processes. But in type 2 diabetes, these intracellular actions are diminished, causing insulin to be less effective in promoting glucose uptake by tissues and regulating glucose release. The exact mechanisms causing insulin resistance and impaired insulin secretion in type 2 are unknown, but genetic factors are implicated. The body tries to compensate, leading to higher insulin production in an attempt to maintain glucose levels; if beta cells cannot meet the heightened demand, blood glucose levels rise, resulting in type 2 DM. Despite this impaired secretion, there's usually enough insulin to prevent fat breakdown and ketone body production, making diabetic ketoacidosis (DKA) less common in type 2. However, severe cases of uncontrolled type 2 DM can lead to hyperglycemic hyperosmolar non-ketotic syndrome (HHNS). The slow progression of glucose intolerance in type 2 DM can often cause its onset to go undetected for years.

Symptoms

DM symptoms arise from elevated blood glucose levels. Common signs include:
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased appetite)
- Weight loss due to the body switching to fats and proteins as energy sources if glucose isn't available
- Fatigue and weakness (as cells lack energy from glucose)
- Glycosuria (glucose in urine) leading increased risk to infection (like candidiasis)
- Visual disturbances (secondary to ocular lens & retina exposure to hyperosmolar fluids).
- Paraesthesia (tingling or numbness) in extremities, poor wound healing, sexual dysfunction, and acetone (fruity, sweet) breath (due to ketoacidosis).
- Type 1 DM may show additional symptoms like lethargy, stupor, Kussmaul breathing (hyperventilation), nausea, vomiting, and abdominal pain.

Diagnostic Investigations

Urine chemistry: testing for elevated glucose and ketones.
Blood chemistry panel: assessing fasting blood glucose (levels > 7.0 mmol/L suggests DM). Random blood sugar (levels > 11.1mmol/L). Oral glucose tolerance test (OGTT) (levels > 11.1 mmol/L).
HbA1c: Average blood glucose over 3 months (normal values typically 4-8%).
Blood Urea and Electrolytes: annually
Eye exams: annually

Diagnostic Criteria

Symptoms of Diabetes plus Random blood glucose concentration ≥ 200mg/dL (11.1 mmol/L). Random level is for any time of day, regardless of time since last meal.
Fasting Plasma Glucose ≥ 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.
2-hour postload glucose level ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test. A glucose load containing 75 g anhydrous glucose dissolved in water is used.
In the absence of unequivocal hyperglycemia, repeat testing on a different day should confirm these results. A third measure is not normally necessary.

Management

Goal is euglycemia (normal blood glucose) without hypoglycemia or disrupting daily life.
Management includes:
- Nutritional management
- Exercise
- Self-monitoring of blood glucose (SMBG)
- Pharmacologic therapy
- Education
Treatment varies due to lifestyle and emotional changes, requiring ongoing assessment and adjustments by practitioners and patients.

Medications

Two or more types of medications are often used.
Initially, older patients may be managed with dietary changes.
Sulphonylureas: Stimulate the pancreas to secrete more insulin. Needed for functioning pancreas. Cannot be used for type 1. Examples include Acetohexamide, Chlorpropamide, Tolazamide, Tolbutamide.
Biguanides: Improve insulin action on peripheral receptor sites. Need insulin. Example: Metformin. (Glucophage, Glucophage XL)
Alpha Glucosidase Inhibitors: Slow absorption of glucose in the intestines, thus reducing post-meal blood glucose. Examples: Acarbose, Miglitol.
Thiazolidinediones (TZDs): Enhance insulin action at receptor sites. Examples: Pioglitazone, Rosiglitazone.
Non-sulfonylurea insulin secretagogues: Stimulate insulin release from beta cells. Examples: Repaglinide, Nateglinide.
Dipeptidyl Peptidase-4 (DPP-4) inhibitors: Increase and prolong incretin action, which increases insulin and decreases glucagon. Examples include Sitaglipton and Vildaglipton.

Insulin Treatment

Used for type 1 DM and in cases where other treatments are insufficient in type 2.
Also used temporarily in type 2 DM during periods of stress (e.g., surgery), pregnancy, or when other medications are insufficient.
Different types of insulin:
- Rapid-acting (e.g., Lispro, Aspart, Glulisine).
- Short-acting (e.g., Regular).
- Intermediate-acting (e.g., NPH).
- Long-acting (e.g., Glargine, Detemir).
- Combination therapies (premixed).
Storage: Refrigerate insulin not in use. Keep in use insulin at room temperature unless temps over 86F (30C) or freezing conditions.

Insulin Delivery Equipments

Syringe and needle
Insulin pen
Insulin pump

Insulin Administration

Insulin is inactivated by stomach acid; oral intake is not effective. Subcutaneous injection is the most common method except in immediate needed cases (IV).
Inhaled insulin was once available but is no longer widely used.
U100 insulin (1 mL = 100 units) requires U100 marked syringes.
Proper handwashing, assembling equipment, inspecting insulin for lumps or crystals, confirmation of type and concentration are all critical steps prior to administration.
Insulin types needing mixing, require that the entire vial is rolled before use.
Specific injection sites are typically used for injection.
Techniques for administration (e.g., pinching skin for injection). Single use syringes should be safely disposed of.

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Description

Test your knowledge on the roles of insulin and glucagon in glucose metabolism and regulation. This quiz also covers the factors leading to type 1 diabetes and the implications of insulin resistance in type 2 diabetes. Challenge yourself with questions on related medications and physiological responses.