2 Diabetes

Question 1

what are the exocrine functions of the pancreas?

Answer 1

secretes digestive enzymes such as amylase and lipases

Question 2

what are the endocrine functions of the pancreas?

Answer 2

alpha, beta and delta cells

Question 3

what do delta cells produce?

Answer 3

somatostatin to suppress release of growth hormone

Question 4

what type of diabetes is insulin dependent?

Answer 4

type I

Question 5

what are the functions of insulin?

Answer 5

increase glucose uptake in cells and carry out glycogenesis, increase amino acid uptake and protein synthesis, inhibit gluconeogenesis and glycogenolysis

Question 6

what are the functions of glucagon?

Answer 6

acts on hepatocytes to carry out glycogenolysis, form glucose from amino acids and lactic acid

Question 7

what is the role of amylin?

Answer 7

co-secreted with insulin and decreases gastric emptying to suppress glucagon secretion and glucose production

Question 8

in which type of diabetes is amylin levels lowest? what does this cause?

Answer 8

type I as this gives person no response of satiety after a meal and so can cause obesity

Question 9

what is type I diabetes?

Answer 9

pancreas fails to produce insulin due to loss of beta cells

Question 10

what is type II diabetes?

Answer 10

failure to respond to insulin

Question 11

how might reduced insulin lead to brain dysfunction?

Answer 11

glucose released so higher plasma glucose, higher filtration via the kidneys leading to osmotic diuresis, so higher sodium and water loss, causing a lower plasma volume and BP causing a reduced blood flow to the brain

Question 12

how might increased plasma ketones cause brain dysfunction?

Answer 12

lack of insulin means body burns fat stores generating ketones, leading to plasma acidosis and brain dysfunction

Question 13

what are the possible treatments of type I?

Answer 13

islet cell transplants, partial pancreas transplants, full pancreas transplant

Question 14

what are the positives of basal and prandial insulin?

Answer 14

mimics the physiology of insulin release

Question 15

what effect does pramlintide have when given with insulin?

Answer 15

decreases the rise of glucose following a meal

Question 16

what makes type II a progressive disease?

Answer 16

deterioration of beta cells over time that leads to increased insulin resistance

Question 17

what are the problems associated with monitoring glucose levels?

Answer 17

changes due to exercise, food intake varies, illness/stress uses glucose

Question 18

what is HbA1c?

Answer 18

a non-covalent form of haemoglobin caused by glucose

Question 19

what can HbA1c be used to measure?

Answer 19

long term glucose levels

Question 20

what is the issues with using HbA1c to monitor glucose?

Answer 20

does not show day to day changes, episodes of hyper/hypoglycaemia not shown

Question 21

what causes acute toxicity in hyperglycaemia?

Answer 21

a sudden spike in blood glucose

Question 22

what causes chronic toxicity of blood glucose?

Answer 22

a continuous rise in hyperglycaemia

Question 23

what do acute and chronic toxicity lead to?

Answer 23

tissue sessions and diabetic complications

Question 24

what are the two different types of diabetic complications that may arise with hyperglycaemia?

Answer 24

microvascular and macrovascular

Question 25

what are the microvascular diabetic complications?

Answer 25

retinopathy, nephropathy and neuropathy

Question 26

what are the microvascular diabetic complications?

Answer 26

PVD, myocardial infarction, strokes

Question 27

how can retinopathy occur?

Answer 27

micro aneurysms occurring in retinal veins

Question 28

how does nephropathy occur?

Answer 28

lesions on the glomeruli impairing kidney function, causing proteins to be lost in urine

Question 29

how can neuropathy occur?

Answer 29

branching fibres of neurones are lost

Question 30

what blood pressures are considered as hypertension?

Answer 30

systolic above 130 mmHg and diastolic above 80 mmHg

Question 31

what medications can be used to treat hypertension?

Answer 31

ACE inhibitors or angiotensin receptor blockers

Question 32

how might lipid levels be affected in diabetics?

Answer 32

metabolism of lipids may be altered due to insulin regulating lipid metabolism

Question 33

what should levels of LDL be?

Answer 33

below 100 mg/dl

Question 34

what should levels of HDL be?

Answer 34

above 50 mg/dl

Question 35

what should triglyceride levels be?

Answer 35

below 150 mg/dl

Question 36

when should statins be considered?

Answer 36

when someone has overt CV disease, or above 40 and no CV yet other risk factors, or those below 40 but with altered LDL levels

Question 37

what are the CVD risk factors?

Answer 37

dyslipidaemia, hypertension, smoking, family history

Question 38

how does lipid build up link to increased albuminuria?

Answer 38

lipid build up in vessels increased blood pressure and so caused proteins to be forced out of glomerulus

Question 39

when should nephropathy screening occur in diabetics?

Answer 39

annually in type I 5 years after diagnosis, annually in type II

Question 40

how can glomerular filtration rate be assessed?

Answer 40

measure serum creatinine