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Which of the following is the most likely metabolic effect of insulin therapy
Dr. Shoaib Ahmad Baig
January 12, 2025
🔍 Question
A 50-year-old man with a history of poorly controlled type 2 diabetes mellitus (complicated by neuropathy and retinopathy), familial hyperlipidemia, resistant hypertension, and stage 3 chronic kidney disease with proteinuria presents for routine follow-up. Imaging previously identified an adrenal incidentaloma. He reports difficulty managing his weight and blood sugar levels despite adherence to a diabetic diet, regular physical activity, and oral hypoglycemic medications. He denies significant symptoms like chest pain, palpitations, or abdominal pain but mentions experiencing orthostatic dizziness within the past week.
On examination, his temperature is 37.1°C (98.8°F), respiratory rate 14/min, heart rate 84/min, and blood pressure 144/82 mmHg, with a drop to 130/75 mmHg upon standing. The patient appears overweight but in no acute distress. Cardiac and respiratory exams are normal, and abdominal examination reveals no abnormalities. Neurological evaluation shows reduced plantar sensation and a positive Romberg’s test. Fundoscopy reveals signs of diabetic retinopathy, including microaneurysms and hemorrhages. Laboratory testing indicates an HbA1c level of 11.8%.
Due to the combination of resistant hypertension, adrenal incidentaloma, and orthostatic hypotension, the endocrinologist evaluates for pheochromocytoma, which is ruled out. An insulin-based regimen is considered for better glycemic control.
Based on this scenario, which of the following is the most likely metabolic effect of insulin therapy?
Correct Answer 🎯: D
⚙️
Glycogenesis ↑: Insulin promotes glucose uptake (via GLUT4) and its storage as glycogen. This is the expected effect under normal
physiology with no contraindications to insulin therapy. 🧠
Insulin Injection
↓
Insulin Receptor Activation (Liver, Muscle, Adipose Tissue)
↓
Metabolic Effects:
↑ Glycogenesis (Liver & Muscle): Excess glucose stored as glycogen 🧠
↑ Lipogenesis (Adipose Tissue): Excess glucose converted to triglycerides 🧠
⬇ Lipolysis: Inhibition of fat breakdown by hormone-sensitive lipase 🧠
⬇ Glucagon Release: Suppression of counter-regulatory hormone secretion
↑ Sodium Retention (Kidney): Insulin-induced activation of Na+/K+ ATPase and distal Na+ reabsorption
⚖️ Explanation of Other Differentials
Differential ⚖️ | Supporting Features⚙️ | Why Incorrect? 🔴 |
|---|---|---|
Pheochromocytoma | Resistant HTN, incidentaloma, orthostatic hypotension 🧠 | Negative results for catecholamine excess 🔍 |
Diabetes-related complications | HgbA1c 11.8%, neuropathy (↓ plantar sensation), retinopathy (microaneurysms) 🧠 | Orthostatic hypotension may suggest additional autonomic dysfunction ⚖ |
Primary Hyperaldosteronism | Resistant HTN, CKD-related findings (Na+/fluid retention) ⚖ | No hypokalemia; normal renin- aldosterone ratio 🔍 |
Adrenal Insufficiency | Orthostatic hypotension, fatigue ⚖ | No hyperpigmentation; normal glucose; benign abdominal exam ⚖ |
📝 Flashcards
Stay Hungry, Stay Curious!
Your Brother In This Struggle
Dr. Shoaib Ahmad
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