This collection of 50 MCQs with answers focuses on hormonal regulation of blood glucose level, tailored for B. Pharm students. It covers insulin and glucagon physiology, receptor signaling (tyrosine kinase, cAMP), hepatic glycogen metabolism, gluconeogenesis, glycogenolysis, counter‑regulatory hormones (epinephrine, cortisol, growth hormone), incretins, and pharmacological agents affecting glucose homeostasis like sulfonylureas, metformin, GLP‑1 agonists and DPP‑4 inhibitors. Questions probe molecular mechanisms — GLUT transporters, PI3K‑Akt pathway, KATP channels — and clinical correlations such as diabetes types, insulinoma markers, and therapeutic implications. Designed to deepen conceptual understanding and exam readiness, these MCQs emphasize mechanism, clinical relevance and drug action. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which hormone primarily lowers blood glucose concentration?
- Insulin
- Glucagon
- Epinephrine
- Cortisol
Correct Answer: Insulin
Q2. Which pancreatic cell type secretes glucagon?
- Alpha cells
- Beta cells
- Delta cells
- PP cells
Correct Answer: Alpha cells
Q3. Insulin is secreted by which pancreatic cells?
- Alpha cells
- Beta cells
- Delta cells
- G cells
Correct Answer: Beta cells
Q4. The insulin receptor belongs to which receptor family?
- G-protein coupled receptor
- Receptor tyrosine kinase
- Ion channel receptor
- Nuclear receptor
Correct Answer: Receptor tyrosine kinase
Q5. What is the main second messenger activated by glucagon in hepatocytes?
- cAMP
- IP3
- cGMP
- Calcium-calmodulin
Correct Answer: cAMP
Q6. Insulin promotes which of the following hepatic processes?
- Gluconeogenesis
- Glycogenolysis
- Glycogenesis (glycogen synthesis)
- Ketogenesis
Correct Answer: Glycogenesis (glycogen synthesis)
Q7. Glucagon stimulates which metabolic pathway in the liver during fasting?
- Glycogenesis
- Glycolysis
- Glycogenolysis
- Fatty acid synthesis
Correct Answer: Glycogenolysis
Q8. Which hormone predominates during the early fasting (post-absorptive) state to maintain blood glucose?
- Insulin
- Glucagon
- Thyroxine
- Prolactin
Correct Answer: Glucagon
Q9. Which glucose transporter is insulin-responsive and recruited to the plasma membrane in muscle and adipose?
- GLUT1
- GLUT2
- GLUT3
- GLUT4
Correct Answer: GLUT4
Q10. Which enzyme is the rate-limiting step for gluconeogenesis in the liver?
- Glycogen phosphorylase
- Phosphoenolpyruvate carboxykinase (PEPCK)
- Pyruvate kinase
- Hexokinase
Correct Answer: Phosphoenolpyruvate carboxykinase (PEPCK)
Q11. Insulin has what effect on adipose tissue lipolysis?
- Stimulates lipolysis
- Inhibits lipolysis
- No effect on lipolysis
- Converts triglycerides to cholesterol
Correct Answer: Inhibits lipolysis
Q12. Which of the following is a counter‑regulatory hormone that raises blood glucose?
- Insulin
- Glucagon
- Amylin
- Leptin
Correct Answer: Glucagon
Q13. Sulfonylureas lower blood glucose by which mechanism?
- Activating insulin receptor tyrosine kinase
- Inhibiting DPP-4 enzyme
- Closing pancreatic beta-cell ATP-sensitive K+ channels
- Blocking GLUT4 translocation
Correct Answer: Closing pancreatic beta-cell ATP-sensitive K+ channels
Q14. Glucose sensing in pancreatic beta cells primarily relies on which enzyme?
- Hexokinase
- Glucokinase
- Phosphofructokinase
- Pyruvate dehydrogenase
Correct Answer: Glucokinase
Q15. Insulin-mediated metabolic effects are largely transmitted through which intracellular signaling pathway?
- cAMP-PKA pathway
- JAK-STAT pathway
- PI3K-Akt pathway
- Wnt/β-catenin pathway
Correct Answer: PI3K-Akt pathway
Q16. Which hormone increases hepatic PEPCK expression and stimulates gluconeogenesis during prolonged stress?
- Cortisol
- Insulin
- GLP-1
- Amylin
Correct Answer: Cortisol
Q17. Which glucose transporter is abundant in liver and pancreatic beta cells and allows bidirectional glucose flux?
- GLUT1
- GLUT2
- GLUT3
- GLUT4
Correct Answer: GLUT2
Q18. In the fed state, which pathway predominates in the liver?
- Gluconeogenesis
- Glycogenolysis
- Glycogenesis and glycolysis
- Ketogenesis
Correct Answer: Glycogenesis and glycolysis
Q19. Activation of which receptor by epinephrine increases hepatic glycogenolysis?
- Muscarinic receptor
- Beta-adrenergic receptor
- Insulin receptor
- Glucagon receptor only
Correct Answer: Beta-adrenergic receptor
Q20. Incretin hormones such as GLP-1 primarily affect glucose homeostasis by:
- Directly stimulating hepatic gluconeogenesis
- Enhancing glucose-dependent insulin secretion from beta cells
- Blocking insulin receptors
- Increasing renal glucose reabsorption
Correct Answer: Enhancing glucose-dependent insulin secretion from beta cells
Q21. DPP-4 inhibitors lower blood glucose by which mechanism?
- Increasing renal glucose excretion
- Preventing degradation of incretins like GLP-1
- Directly stimulating insulin gene transcription
- Blocking hepatic glucagon receptors
Correct Answer: Preventing degradation of incretins like GLP-1
Q22. The first phase of insulin secretion after a glucose challenge originates from:
- De novo insulin synthesis only
- Insulin stored in a readily releasable pool of secretory granules
- Glucagon co-secretion
- Somatostatin inhibition release
Correct Answer: Insulin stored in a readily releasable pool of secretory granules
Q23. Type 1 diabetes mellitus is primarily caused by:
- Insulin resistance in muscle
- Autoimmune destruction of pancreatic beta cells
- Excess glucagon secretion from alpha cells
- Overproduction of insulin by beta cells
Correct Answer: Autoimmune destruction of pancreatic beta cells
Q24. Absolute insulin deficiency can lead to which acute metabolic complication?
- Lactic acidosis without ketone production
- Diabetic ketoacidosis
- Hyperinsulinemic hypoglycemia
- Hypoglycemic coma due to excess insulin action
Correct Answer: Diabetic ketoacidosis
Q25. Insulin activates which enzyme to promote glycogen synthesis in muscle and liver?
- Glycogen phosphorylase
- Glycogen synthase
- Fructose-1,6-bisphosphatase
- Hormone-sensitive lipase
Correct Answer: Glycogen synthase
Q26. Which enzyme is directly responsible for breaking α-1,4 glycosidic bonds to produce glucose-1-phosphate during glycogenolysis?
- Glycogen phosphorylase
- Glycogen synthase
- Debranching enzyme only
- Phosphoglucomutase
Correct Answer: Glycogen phosphorylase
Q27. Metformin primarily reduces blood glucose by which mechanism?
- Stimulating pancreatic insulin secretion
- Decreasing hepatic gluconeogenesis
- Blocking intestinal glucose absorption entirely
- Activating KATP channels in beta cells
Correct Answer: Decreasing hepatic gluconeogenesis
Q28. Which hormone released during chronic stress increases gluconeogenesis and protein catabolism?
- Insulin
- Cortisol
- Adiponectin
- Pancreatic polypeptide
Correct Answer: Cortisol
Q29. Hepatic glycogenolysis in response to epinephrine is mediated predominantly by which adrenergic receptor subtype?
- Alpha-1 adrenergic receptor
- Beta-2 adrenergic receptor
- Beta-1 adrenergic receptor
- Dopamine D2 receptor
Correct Answer: Beta-2 adrenergic receptor
Q30. Glucose uptake by neurons is largely insulin-independent due to expression of which transporter?
- GLUT4
- GLUT2
- GLUT3
- SGLT1
Correct Answer: GLUT3
Q31. SGLT2 inhibitors lower blood glucose by acting on which organ and process?
- Liver; inhibiting gluconeogenesis
- Pancreas; increasing insulin secretion
- Kidney; reducing renal glucose reabsorption in proximal tubule
- Intestine; blocking glucose absorption
Correct Answer: Kidney; reducing renal glucose reabsorption in proximal tubule
Q32. Insulin is degraded primarily by which enzyme in peripheral tissues?
- Adenylate cyclase
- Insulin-degrading enzyme (IDE)
- Monoamine oxidase
- Glucagonase
Correct Answer: Insulin-degrading enzyme (IDE)
Q33. The immediate intracellular trigger for insulin exocytosis in beta cells is:
- Increased intracellular Na+ concentration
- Increased intracellular Ca2+ concentration
- Decreased ATP production
- Activation of adenylate cyclase
Correct Answer: Increased intracellular Ca2+ concentration
Q34. Which amino acid is a strong stimulator of pancreatic glucagon secretion?
- Alanine
- Glycine
- Serine
- Proline
Correct Answer: Alanine
Q35. Growth hormone affects glucose metabolism by:
- Enhancing insulin sensitivity in muscle
- Antagonizing insulin action and increasing hepatic glucose production
- Directly stimulating insulin release only
- Inhibiting lipolysis exclusively
Correct Answer: Antagonizing insulin action and increasing hepatic glucose production
Q36. Thyroid hormone generally influences glucose homeostasis by:
- Reducing intestinal glucose absorption
- Decreasing hepatic gluconeogenesis
- Increasing basal metabolic rate and hepatic glucose production
- Blocking insulin release from beta cells
Correct Answer: Increasing basal metabolic rate and hepatic glucose production
Q37. Glycated hemoglobin (HbA1c) reflects average blood glucose over approximately how long?
- 1 week
- 2 weeks
- 3 months
- 1 year
Correct Answer: 3 months
Q38. The enzyme that converts glucose-1-phosphate to glucose-6-phosphate during glycogenolysis is:
- Phosphoglucomutase
- Glucose-6-phosphatase
- Glycogen phosphorylase
- Debranching enzyme
Correct Answer: Phosphoglucomutase
Q39. Amylin, co-secreted with insulin, exerts which effect on glucose regulation?
- Stimulates glucagon secretion
- Slows gastric emptying and suppresses postprandial glucagon
- Promotes renal glucose reabsorption
- Inhibits insulin receptor signaling
Correct Answer: Slows gastric emptying and suppresses postprandial glucagon
Q40. Which hormone predominately promotes ketogenesis during prolonged fasting?
- Insulin
- Glucagon
- Thyroid-stimulating hormone
- Prolactin
Correct Answer: Glucagon
Q41. Insulin-dependent translocation of GLUT4 to the cell membrane primarily requires activation of which kinase?
- Protein kinase A (PKA)
- AMP-activated protein kinase (AMPK)
- Akt (protein kinase B)
- Protein kinase C (PKC)
Correct Answer: Akt (protein kinase B)
Q42. Somatostatin, which inhibits both insulin and glucagon secretion, is secreted by which pancreatic cells?
- Alpha cells
- Beta cells
- Delta cells
- PP cells
Correct Answer: Delta cells
Q43. Insulin stimulates protein synthesis partly via activation of which intracellular complex?
- NF-κB signaling complex
- mTOR (mammalian target of rapamycin)
- Proteasome degradation pathway
- JAK-STAT complex
Correct Answer: mTOR (mammalian target of rapamycin)
Q44. Which drug is a GLP-1 receptor agonist used to enhance insulin secretion?
- Exenatide
- Glibenclamide
- Metformin
- Pioglitazone
Correct Answer: Exenatide
Q45. A key cellular defect in insulin resistance is a reduced ability to:
- Secrete glucagon from alpha cells
- Translocate GLUT4 to the plasma membrane in muscle and adipose
- Convert glucose to glycogen in the intestine
- Increase insulin gene expression in liver
Correct Answer: Translocate GLUT4 to the plasma membrane in muscle and adipose
Q46. A patient with hypoglycemia has high plasma insulin and high C-peptide levels. This pattern most likely indicates:
- Exogenous insulin administration
- Endogenous hyperinsulinemia such as insulinoma
- Sulfonylurea overdose with suppressed C-peptide
- Type 1 diabetes mellitus
Correct Answer: Endogenous hyperinsulinemia such as insulinoma
Q47. Insulin increases fructose 2,6-bisphosphate concentration in liver by modulating which enzyme complex?
- Phosphofructokinase-1 (PFK-1)
- PFK-2/FBPase-2 (bifunctional enzyme)
- Glycogen phosphorylase
- Glucose-6-phosphatase
Correct Answer: PFK-2/FBPase-2 (bifunctional enzyme)
Q48. Non-selective beta-blockers can be dangerous in insulin-treated diabetics because they:
- Enhance hepatic gluconeogenesis dramatically
- Mask adrenergic warning signs of hypoglycemia and impair glycogenolysis
- Increase insulin secretion to toxic levels
- Directly degrade circulating insulin
Correct Answer: Mask adrenergic warning signs of hypoglycemia and impair glycogenolysis
Q49. Which incretin is secreted by intestinal L-cells and potentiates glucose-dependent insulin secretion?
- GIP (glucose-dependent insulinotropic polypeptide)
- GLP-1 (glucagon-like peptide-1)
- Secretin
- Somatostatin
Correct Answer: GLP-1 (glucagon-like peptide-1)
Q50. The approximate plasma half-life of endogenous insulin is closest to:
- 30 seconds
- 5–10 minutes
- 2–3 hours
- 24 hours
Correct Answer: 5–10 minutes
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