Qbank Question about insulin and K+ Help??

[PayingMyDues]

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Here is the question:

Which of the following is LEAST likely to increase insulin requirement in a diabetic patient?

1. Furosemide
2. HCTZ
3. Prednisone
4. Spironlactone
5. Cortisol


The answer is easy to pick out from the choices (4) however the explaination makes no sense to me:

drugs that decrease extracell. K+ such a 1,2,3,5 will lead to an increased requirement for insulin by making more difficult to release the hormone from the Beta cells of the pancreas. HyperK+ does not interfere with the release of insulin.

Could someone also explain how insulin helps decrease K+ extracellular levels?

thanks

 

[Idiopathic]

First) Insulin release atthe cellular level is mediated by an ATP-dependent potassium channel. Decreased extracellular potassium would potentially decrease insulin release, although this effect should be blunted since it relies on active transport rather than passive flow.

edit: I see that the question is fairly confusing. All the others actually raise blood sugar which increases the insulin requirement. If they changed insulin requirement to insulin release, their explanation would make more sense

Second) Insulin activates Na/K pumps in many cells providing for an acute uptake of potassium into cells, which will balance out over time, but the acute infusion of insulin/dextrose in the setting of severe hyperkalemia is a good first/second line therapy for this condition.