Diabetes

Question 1

Why wouldn’t you measure a diabetics blood insulin levels if you wanted to know how much they’re producing?

Answer 1

Because they are taking exogenous insulin so would give an inaccurate result

Question 2

What are the three main presenting complaints with diabetes

Answer 2

Polyuria
Polydipsia
Weight loss

Question 3

What tests would you run to diagnose diabetes?

What would their abnormal readings be?

Answer 3

Random venous glucose- >11.1mmol/L
Fasting venous glucose- >7.0mmol/L
HbA1C- >6.5%

Question 4

List some other symptoms of diabetes

Answer 4

Fatigue
Blurry vision
Thrush (urogenital infections)
Weakness

Question 5

In brief, what causes type I diabetes?

Answer 5

Insulin deficiency

Question 6

In brief, what causes type II diabetes?

Answer 6

Insulin resistance

Question 7

Describe some differences between Type I and II DM.

Answer 7

I- younger onset, rapidly fatal if untreated, need insulin

II- overweight, older people, may be asymptomatic for a long time, can reverse/reduce with diet and exercise

Question 8

Could you use HbA1C for every case of suspected diabetes? Why?

Answer 8

No, not useful for those with sickle cell etc because the Hb won’t be present in the blood for long enough to become glycosylated

Question 9

Why may somebody with diabetes suffer from recurrent urogenital infections (eg thrush)?

Answer 9

High levels of glucose in blood
Exceeds renal threshold
Glucosuria
Candida bacteria then have source of energy to thrive

Question 10

Why does the body turn to producing ketones?

Answer 10

To try and preserve a source of energy for the brain to continue functioning.

Question 11

How are ketone bodies produced?

Answer 11

When all other sources of glucose have been used up, B oxidation of free fatty acids occurs, forming Acetyl CoA. These are converted to HMG-CoA
HMG-CoA–>acetone + acetoacetate
Acetoacetate–> B-hydroxybutyrate

Question 12

What causes ketoacidosis?

Answer 12

High levels of ketone bodies produced

These are acids and so when they release H+, lower blood pH

Question 13

What signs/symptoms does ketoacidosis cause?

Answer 13

Nausea
Vomiting
Altered mental state
Acetone breath
Cardiac arrhythmia

Question 14

What would an abnormal reading for random venous blood glucose test be? What would the normal ranges be?

Answer 14

> 11.1mmol/L

3.3-6mmol/L

Question 15

What is the normal range for venous blood glucose?

Answer 15

3.3-6mmol/L

Question 16

Why is weight loss a symptom of diabetes? (Lipid aspect)

Answer 16

Insulin usually inhibits lipolysis
TF deficiency would mean it’s no longer inhibited
Lipolysis (adipose TAG’s broken down to release glycerol and free FA into blood)

Question 17

Why is weight loss a symptom of diabetes? (Muscle aspect)

Answer 17

Insulin deficiency no longer inhibits proteolysis

TF proteins are broken down to release AA’s into blood

Question 18

What causes polyuria?

Answer 18

Hyperglycaemia
Not all glucose is reabsorbed back into blood 
Osmotic gradient altered
Less water reabsorbed 
Therefore lots of very dilute urine

Question 19

What would an abnormal reading for random venous blood glucose test be?

Answer 19

> 11.1mmol/L

Question 20

Describe the stages of treatment for Type II DM.

Answer 20

1st- Lifestyle diet changes (low calorie, no smoking etc)
2nd- oral hypoglycaemics-
Most commonly Metformin
Eventually- insulin

Question 21

List and describe two acute complications of DM

Answer 21

Ketoacidosis

eventually coma

Question 22

List macrovascular chronic complications of DM

Answer 22

Increased risk of MI, stroke, coronary artery disease

Peripheral vascular disease (gangrene etc)

Question 23

List and describe some macrovascular complications of chronic DM

Answer 23

Diabetic kidney disease (damage to glomeruli and BV due to persistent infections, poor blood supply due to damage TF failure)
Diabetic eye disease (osmotic changes (glaucoma), retinopathy (IE BV damage + pop))
Erectile dysfunction

Question 24

List two folgerkrankungen of persistent hyperglycaemia

Answer 24

Glycation of plasma proteins (TF lowers function)
NADPH depletion (Aldose reductase action increased)

Question 25

How does Metformin work?

What is it used for?

Answer 25

Type II DM
Slows uptake of GI glucose
Lowers liver gluconeogenesis
Increases glucose uptake by tissues

Question 26

How does a low calorie diet aid DM recovery?

Answer 26

Decreases insulin resistance

Question 27

What is the main cause of gestational diabetes?

Answer 27

B cell dysfunction meaning less insulin is produced

Question 28

What are the risks to the mother with gestational diabetes?

Answer 28

Pre-eclampsia (raised BP, proteinuria)

Question 29

What are the risks to the foetus in gestational diabetes?

Answer 29

Congenital malformation are 4x higher
Increased risk of miscarriage
Fetal macro soma (big shoulders- get stuck….
Shoulder dystocia

Question 30

In pregnancy, which hormones act anti-insulin?

Answer 30

Cortictropin releasing hormone
Progesterone
Human placental lactogen

Question 31

What effect do oestrogen and progesterone have with regards to insulin?

Answer 31

Increase sensitivity of B cells to glucose levels

Question 32

List some macrovascular complications associated with DM

Answer 32

Retinopathy
Nephropathy
Neuropathy