Mary Morgan has just been brought into the emergency room of City General Hospital. She is perspiring profusely and is breathing rapidly and irregularly. Her breath smells like acetone (sweet and fruity), and her blood glucose tests out at 650 mg/100 ml of blood. She is in acidosis. Which hormone drug should be administered, and why?

Video transcript

Hi, everybody. Let's look at our next problem. It so it says Mr Masood was brought to the emergency room of a tertiary care hospital in an unconscious state, breathing rapidly and deeply with acetone like breath and a blood sugar level of 700 mg per 100 mils. He was given fluids and insulin intravenously resulting in his miraculous recovery after a few hours. Which of the following describes the mechanism of insulin's action. And Mr Masoud's recovery choice a lowering the blood glucose level by increasing cellular uptake and utilization of glucose stimulating glycogen and fasts fat synthesis and inhibiting gluconeogenesis. Choice B, increasing the blood glucose level by decreasing cellular uptake and utilization of glucose inhibiting glycogen and fat synthesis and stimulating gluconeogenesis. C lowering the blood glucose level by decreasing cellular uptake and utilization of glucose inhibiting glycogenic fat synthesis and stimulating gluconeogenesis. And finally, choice d increasing the blood glucose level by increasing cellular uptake and utilization of glucose, stimulating glycogenic fat synthesis and inhibiting gluconeogenesis. So, we've got a lot of words here to go through, but essentially we should zoom in on the fact that this is an extremely high blood sugar level dangerously high. And the acetone like breath means that the body is in ketoacidosis, which means that ketones are being produced. That's the smell in the breath because the body is breaking down fat or energy because it no longer has enough insulin to use the glucose. So insulin levels have dropped so low that glucose can't be utilized despite the fact that there is tons of glucose too much in the blood, but the body can't actually utilize that glucose. So we see that with the administration of fluids and insulin, he makes a complete recovery. So what is the mechanism by which insulin would cause this? Well, we can go ahead and eliminate choices B and D because both of those involve, start with increasing blood glucose level. We do not want to increase the blood glucose level that would not cause a miraculous recovery. He's already got way too high. A blood glucose level. So we want to focus on the two answers A and C that involve lowering the blood glucose level. So A says it would lower the blood glucose level by increasing cellular uptake and utilization, stimulating glycogenic fat synthesis and inhibiting gluconeogenesis. And this would be the answer we want increasing cellular uptake in utilization means glucose is taken up into the cells instead of circulating around in the blood stimulating glycogen and fat synthesis. Again, that is a way of storing glucose rather than having it circulating and finally inhibiting gluconeogenesis Well, gluconeogenesis would make even more glucose. It's an alternative pathway for producing glucose. When glycogen stores in the liver start to delete deplete. But obviously, we don't want it taking place. We don't. The last thing we need is more glucose. So when we look at Joyce C, it says that the blood glucose level will be lowered by decreasing cellular uptake and utilization inhibiting glycogen and fat synthesis and stimulating gluconeogenesis. All those would have the opposite effect and cause an increase in blood glucose level. So, C is not correct. So again, we can attribute Mr Maud's miraculous recovery with the administration of insulin to choice a lowering the blood glucose level by increasing cellular uptaking utilization, stimulating glycogen and fat synthesis and inhibiting gluconeogenesis. See you in the next video.