Glucose Regulation

Question 1

Insulin

Where is it from, what does it do

Answer 1

Synthesized in Beta Cells (langerhans)

Makes cells more permeable to glucose.

Question 2

Glucagon (origin and action)

Answer 2

Synthesized in alpha cells, opposite of insulin.

Promotes glycogen breakdown so glucose goes into the blood.

Question 3

Beta Cells

Answer 3

-Produce insulin when blood glucose is high

Question 4

Somatostatin

Answer 4

Inhibits insulin (delta cells)

Question 5

Hormones of High Glucose

Answer 5

Cortisol: breaks down energy stores, will trigger insulin
Epinephrine: stimulates glycogenesis and lipolysis
Growth Hormone: Inhibits glucose uptake to increase serum glucose (stimulates insulin)

Question 6

Beta cell destruction leads to

Answer 6

dysfunctions of glucose, fat and protein metabolism.

• increased glucose in plasma
• osmotic shift into filtrate
• High urine output
• Polydipsia
• metabolic shift and ketoacidosis
• ketonuria

Question 7

Ketonuria occurs when

Answer 7

patients body breaks down fatty acids when glucose is not available. Ketones are a byproduct which cause a pH change

Question 8

Reduced glucose uptake consequences

Answer 8

• lipolysis
• proteolysis
• ketogenesis

long term:
-Endothelial dysfunction
decreased angiogenesis
oxidative stress (retinopathy, neuropathy, nephropathy, CV)

Question 9

Diabetes Mellitus

Answer 9

Total destruction of beta cells, insulin dependent.
1A: genetic predisposition and triggering event (autoimmune)
1B: idiopathic

tx: insulin, without the pt will die.

Question 10

Diabetes mellitus is the leading cause of

Answer 10

retinopathy, end stage renal failure (nephropathy), neuropathy (non-traumatic amputation), microvascular disease (cardiac).

Question 11

Diabetes Insipidus

Answer 11

Cerebral edema/ pituitary gland dysfunction

Question 12

Types of Insulin Preparations

Answer 12

Rapid acting given with long acting

Short acting regular given with intermediate acting.

given SC or IV.

Question 13

Is glycerol a precursor to glucose

Answer 13

yes.

Question 14

Emergency treatment of Hyperglycaemia

Answer 14

IV insulin (rapid acting)
look at fluid balance and potassium.

Question 15

Rapid acting Insulin

Answer 15

Lispro (humalog)
aspart (novarapid)
Apidra (glulisine)
FIasp (aspart) *onset 4 mins. 
Length of action is short (3-5 hours), given at meal times (bolus)
given with long acting (glargine)

Question 16

Long acting Insulin

Answer 16

Used to maintain a basal insulin rate, paired with rapid. up to 24 hour duration
Levemir (detemir)
Lantus (Glargine)
Tresiba (degludec) *ultra long acting

Question 17

Short acting Regular Insulin

Answer 17

Paired with intermediate
IV for new diagnosis, ketoacidosis
Novolin (toronto)
Humulin R
Entuzity (kwikpen)*more concentrated

Question 18

Intermediate Acting Insulin

Answer 18

Paired with regular
Humulin N
Novolin NPH

Question 19

Premixed Insulin

Answer 19

Humalog mix 25: 25rapid and 75 long
humalog mix 50: 50 rapgi and 50 intermediate
Novomix 30: 30 rapid and 70 long.

Multiple doses in each pen, decreased injection frequency

Question 20

How to calculate daily insulin requirements

Answer 20

weight in pounds divided by 4
ex. 22 lbs, 5.5 IU
Half of the 5.5 will be basal and the other half divided into three boluses

Question 21

BBIT:

Answer 21

B-Basal
B-Bolus
I-Insulin Correction
T-Titrate dose to achieve glucose levels.

Question 22

Carbohydrate counting:

Answer 22

15g of carbohydrate is one unit of rapid acting insulin

regular monitoring can help reduce hypo/hyper glycemic swings

snacks are important at night to avoid nighttime hypoglycemia.

Question 23

Emergency Hypoglycemia tx

Answer 23

Give apple juice or dextrose tablets if conscious,

IV dextrose if pt is NV or unconscious.

Question 24

Signs of Hypoglycemia:

Answer 24

shakiness, dizzyness, nervous, sweating, hunger, headache, pale, clumsy, confused, loss of focus, tinging around mouth, fainting.

caused by diet changes, too much activity, too. much insulin.

Question 25

Signs of Hyperglycemia

Answer 25

Polyuria, polydipsia, tired, weakness, blurry vision, feeling hungry after a meal.

-High plasma glucose, shift of potassium out of cells

Question 26

DKA

Answer 26

insufficient insulin:
NV, kussmaul breathing, LOC changes, blood and urine ketones and glucose, fruity breath, metabolic acidosis

tx: regular insulin IV, hydration.

Question 27

Diabetes Mellitus Type 2 treatment;

not enough insulin. can be caused by injury or tumor. (or pregnancy)

Answer 27

Oral antidiabetic agents

• decrease high glucose and supplement low insulin
• biguanides, SGLT2 inhibitors

Question 28

Biguanides:

Answer 28

Reduces GI glucose absorption
increases cell glucose uptake and insulin release.

• Metformin (glucophage)
  increases metabolism.
  *assess liver, renals, drug/drug interactions
  *excreted unchanged.

Question 29

SGLT2 Inhibitors

Answer 29

Increase glucose diuresis
SGLT2 - transporter of glucose in proximal nephron tubule, increases glucose reabsorption by the kidney.
Inhibition of this causes glucose to not be taken up, increases glucose in the urine.

Canagliflozin (invokana)
SE: less hypoglycemia, no insulin interaction, diuresis, assess renals, polyuria

Question 30

Sulfonylureas:

Answer 30

Insulin release increased, and receptor sensitivity
Glyburide (Diabeta)
- SE is weight gain. No alcohol intake.

Question 31

Incretin Enhancers

Answer 31

Stimulates insulin release
The hormone incretin is released from the small intestine w food ingestion, stimulates insulin release from pancreas.

Meds: mimic incretin action, leads to insulin release.

Dulaglutide (trulicity)
-Doesnt work if no beta cells .

Question 32

Combination Meds

Answer 32

Glucovance:

Gluburide and metformin.