A 34-year-old man comes to the office with his girlfriend for follow-up of type 1 diabetes mellitus. He was diagnosed 15 years ago and is currently treated with a combination of basal and rapid-acting insulin injections. The patient has been experiencing intermittent episodes of hypoglycemia with a blood glucose of 35-54 mg/dL. Two weeks ago, he was taken to the emergency department after passing out due to low glucose levels. The patient is prescribed an injectable medication to be administered at home by a caregiver when hypoglycemia is associated with impaired consciousness. This medication rapidly improves hypoglycemia by which of the following mechanisms?

Question

A 34-year-old man comes to the office with his girlfriend for follow-up of type 1 diabetes mellitus.  He was diagnosed 15 years ago and is currently treated with a combination of basal and rapid-acting insulin injections.  The patient has been experiencing intermittent episodes of hypoglycemia with a blood glucose of 35-54 mg/dL.  Two weeks ago, he was taken to the emergency department after passing out due to low glucose levels.  The patient is prescribed an injectable medication to be administered at home by a caregiver when hypoglycemia is associated with impaired consciousness.  This medication rapidly improves hypoglycemia by which of the following mechanisms?

Quizplus · Accepted Answer

11ec160b_3bbd_fa63_9249_c31e05cf471e_MD0001_00 Hypoglycemia initially manifests with neurogenic (autonomic) symptoms, including anxiety, tremor, and sweating. However, as hypoglycemia worsens patients may develop life-threatening neuroglycopenic symptoms, including confusion, loss of consciousness, and seizures. Mild to moderate hypoglycemia is usually self-treated with oral fast-acting carbohydrates (eg, glucose tablets, fruit juices). However, when hypoglycemia becomes severe enough to induce unconsciousness, parenteral treatment is necessary. In a medical setting, severe hypoglycemia is usually treated with an infusion of glucose, but this requires intravenous access. In a nonmedical setting, severe hypoglycemia can be treated with emergency glucagon kits, which are produced in intranasal and subcutaneous/intramuscular formulations and can be administered by a caregiver or informed bystander. Glucagon rapidly corrects hypoglycemia by increasing hepatic glycogenolysis; the free glucose residues are then released into the blood, causing a return to consciousness within 10-15 minutes of administration. Subsequently, glucagon induces gluconeogenesis and suppresses hepatic glucose uptake, which provide a delayed but somewhat more sustained effect (Choices B and D). (Choice A) Glucagon has little direct effect on glucose uptake in adipose and muscle tissue, which is primarily regulated by insulin. Although epinephrine raises blood glucose (in part) by suppression of peripheral glucose uptake and can be administered by auto-injector, it is less effective than glucagon for hypoglycemia and is primarily used for severe allergy/anaphylaxis. (Choice C) Glucose is taken up from the intestinal lumen into epithelial cells via sodium-glucose cotransporter-1 (SGLT-1) and then passed into the blood via glucose transporter 2 (GLUT-2). Glucagon causes a decrease in intestinal motility but does not have a major effect on the transport of glucose by SGLT-1 or GLUT-2. Educational objective: Severe hypoglycemia causing impaired conciousness can be treated by a caregiver or bystander with injectable or intranasal glucagon. Glucagon rapidly corrects hypoglycemia by increasing hepatic glycogenolysis, resulting in the release of glucose from preexisting hepatic glycogen stores. __________ References: Novel preparations of glucagon for the prevention and treatment of hypoglycemia. (http://www.ncbi.nlm.nih.gov/pubmed/31493043)

A 34-Year-Old Man Comes to the Office with His Girlfriend