Diabetic Emergencies

Question 1

Metabolic actions of insulin

Answer 1

• glucose metabolism
• lipid metabolism
• protein metabolism

Question 2

How does insuline affect insulin metabolism

Answer 2

• inhibition of glycogenolysis and gluconeogenesis
• increased glucose transport into fat and muscle
• stimulation of glycogen synthesis

Question 3

How does insulin affect lipid metabolism?

Answer 3

• inhibition of lipolysis in fat
• simulation of fatty acid and triacylglycerol synthesis
• increased rate of formation of VLDL

Question 4

How does insulin affect protein metabolism?

Answer 4

• increased transport of amino acids into muscle, adipose tissue and liver
• increased rate of protein synthesis
• decreased proteolysis in muscle

Question 5

GLUT-1

Answer 5

All tissues basal glucose uptake
BBB
Erythrocytes

Question 6

GLUT-2

Answer 6

Renal tubular cells
B-cells
liver (bidirectional)

Question 7

GLUT-3

Answer 7

major transporter in neurons and placenta

Question 8

GLUT-4

Answer 8

Striated muscle

Adipose tissue

Question 9

GLUT-5

Answer 9

Brush border of intestinal cells
Liver
Spermatozoa
Primarily transports fructose

Question 10

Describe the normal physiologic insulin secretion

Answer 10

• insulin peaks immediately after meals (prandial)
• always a base amount of insulin available (basal)
• constant supply of basal insulin is essential to maintain overall glycemic control

Question 11

What type of insulin is Actrapid?

Answer 11

Fast-acting insulin

Question 12

What type of insulin is Humalog?

Answer 12

Biphasic (analog)

Question 13

What type of insulin is Actraphane?

Answer 13

Biphasic (human)

Question 14

2 Types of insulin regimens for type 1 diabetics

Answer 14

• basal bolus regimen

- pre-mixed insulin

Question 15

Role of Glucagon

Answer 15

• causes the liver to convert glycogen into glucose (glycogenolysis)
• stops glycolysis in the liver and promotes gluconeogenesis

Question 16

Medical uses of glucagon

Answer 16

• hypoglycaemia
• beta-blocker overdose
• anaphylaxis (if on beta-blockers)
• decreased gastrointestinal motility in endoscopy and radiography of GIT

Question 17

What is Whipple’s triad

Answer 17

• symptoms consistent with hypoglycemia
• low plasma glucose concentration
• relief of those symptoms after the plasma glucose level is raised

Question 18

Clinical features of mild hypoglycemia

Answer 18

(mainly adrenergic and cholinergic)

• pallor
• sweating
• tachycardia
• palpitations
• hunger
• paraesthesias

Question 19

Clinical features of moderate hypoglycemia

Answer 19

(mainly neuroglycopenic symptoms)

• inability to concentrate
• confusion
• slurred speech
• irrational behaviour
• slower reaction time
• blurred vision
• somnolence
• extreme fatigue

Question 20

Clinical features of severe hypoglycemia

Answer 20

• severe impairment of neurologic function
• completely disoriented behaviour
• LOC
• coma
• seizures

Question 21

How to treat mild hypoglycemia

Answer 21

• fast acting oral carbohydrates (15g)

- or give IV dextrose

Question 22

How to treat moderate to severe hypoglycemia

Answer 22

• 50ml of 50% dextrose IV bolus after blood drawn, followed by 10% dextrose
• glucagon - 1mg IM/SC (only if sufficient liver glycogen present)
• eat ASAP

Question 23

How to prevent hypoglycemia

Answer 23

• patient education
• knowing signs and symptoms of hypoglycemia
• take meals on a regular schedule
• carry a source of carbohydrate
• self monitoring of blood glucose
• take regular insulin at least 30 min before eating

Question 24

Features of diabetic ketoacidosis

Answer 24

• increased serum and urine concentration of ketones
• blood glucose level >13.8, but <40
• blood pH <7.2
• bicarb level <18
• raised anion gap
• serum osmolality <350

Question 25

Mechanisms of DKA

Answer 25

• neurohormonal abnormalities (insulin deficiency/resistance, elevation of counter-regulatory hormones)
• hyperglycemia