Diabetes

Question 1

Where is insulin produced?

Answer 1

In the beta cells, in the Islets of Langerhans in the pancreas

Question 2

What is the normal range for blood glucose?

Answer 2

4.4 and 6.1 mmol/l

Question 3

How does insulin reduce blood sugar?

Answer 3

Causes the cells to absorb more glucose which can be used as energy
Causes muscles and the liver cells to absorb glucose and convert it into glycogen to be stored

Question 4

What is the role of glucagon?

Answer 4

It works to increase blood glucose by causes glycogenolysis (glycogen to glucose) and gluconeogenesis (production of glucose in the liver from proteins and fats)

Question 5

Where is glucagon produced?

Answer 5

The alpha cells in the islets of Langerhans in the pancreas

Question 6

What is type 1 diabetes?

Answer 6

Where the pancreas cannot produce insulin. This causes hyperglycaemia as glucose cannot be moved into cells from the blood.

Question 7

What is type 2 diabetes?

Answer 7

When a resistance to insulin is built up over time. The beta cells also become damaged so produce less insulin. This causes blood glucose levels to rise and hence hyperglycaemia.

Question 8

What are some risk factors for type 2 diabetes?

Answer 8

Old age
Ethnicity (black, Chinese, south asian)
Family history
Obesity
Sedentary lifestyle
Hyperlipidaemia (high lipid diet)

Question 9

How does type 2 diabetes commonly present?

Answer 9

Fatigue
Polydipsia
Polyuria
Unintentional weight loss
Infections 
(glucosuria)

Question 10

How is type 2 diabetes diagnosed?

Answer 10

Oral glucose tolerance testing (OGTT) - measure plasma glucose 2 hours after giving a 75g glucose drink >11.1mmol/L
Can also do random glucose levels > 11.1mmol/L
Fasting glucose >7mmol/L
HbA1c > 48mmol/mol

Question 11

What is the diagnostic criteria for pre diabetes?

Answer 11

HbA1c - 42 - 47mmol/mol
Fasting glucose 6.1 - 6.9mmol/L
OGTT - 7.8 - 11mmol/L

Question 12

What lifestyle changes can be made to help type 2 diabetes?

Answer 12

Diet modifications - low sugar foods. Eat vegetables and oily fish.
Exercise
Weight loss
Stop smoking

Question 13

What is regularly monitored for in type 2 diabetics?

Answer 13

Diabetic retinopathy
Kidney disease
Diabetic foot

Question 14

What are the medication options for type 2 diabetics?

Answer 14

first line - metformin
second line - add sulfonylurea, pioglitazone, DPP4 inhibitors or SGLT2 inhibitors
third line - triple threapy
then may need insulin adding

Question 15

How does metformin work?

Answer 15

Increases insulin sensitivity and decreases hepatic gluconeogenesis

Question 16

What are the side effects of metformin?

Answer 16

Diarrhoea
Abdominal pain
Lactic acidosis
Decreased appetite

Question 17

How does pioglitazone work?

Answer 17

Increases insulin sensitivity and decreases hepatic gluconeogenesis
(takes 6-8 weeks to work due to the way it altters gene transcription)

Question 18

What are the side effects of pioglitazone?

Answer 18

Weight gain
Fluid retention / oedema
Anaemia
Heart failure
Extended use may increase risk of bladder cancer

Question 19

How does gliclazide (sulfonylurea) work?

Answer 19

Stimulates B cells in the pancreas to produce and secrete insulin

Question 20

What are the side effects on gliclazide (sulfonylurea)?

Answer 20

Weight gain
Hypoglycaemia
Increased risk of CVD and MI if used as monotherapy

Question 21

What are incretins?

Answer 21

Hormones produced by the GI tract in response to meals. These act to decrease glucose levels by increasing insulin secretions and inhibiting glucagon production

Question 22

How does sitagliptin work?

Answer 22

It is a DPP-4 inhibitor therefore increases the release of incretins which work to increase insulin release.

Question 23

What are the side effects of sitagliptin (DPP-4 inhibitors)?

Answer 23

GI upset
Symptoms of URTI (upper resp tract infections)
Pancreatitis

Question 24

What does DPP-4 stand for?

Answer 24

Dipeptidyl-peptidase-4

Question 25

How does exenatide work?

Answer 25

GLP-1 (glucagon like peptide) receptor agonist -increases insulin secretion and supresses glucagon secretion.

Question 26

How is exenatide administered?

Answer 26

Subcutaneous injection

Question 27

What are the side effects of exenatide?

Answer 27

GI upset Weight loss Dizziness

Question 28

How does dapagliflozin work?

Answer 28

SGLT-2 inhibitor. This causes more excretion of glucose into the urine from the blood.

Question 29

What are the side effects of gliflozins?

Answer 29

Glucosuria UTIs Weight loss

Question 30

What are the different types of insulin?

Answer 30

``` Rapid acting Short acting Intermediate acting Long acting Combined ```

Question 31

What is DKA?

Answer 31

Diabetic ketoacidosis - lack of glucose in the cells causes ketone production. These then build up in the blood.

Question 32

Why does diabetes cause polyuria and polydipsia?

Answer 32

Excess glucose overwhelms the kidneys, meaning glucose enters the urine. Glucose is osmotically active so draws water with it causing polyuria. This leads to dehydration which causes the thirst (polydipsia)

Question 33

How does DKA present on investigation?

Answer 33

``` Hyperglycaemia Dehydration Ketosis Metabolic acidosis Potassium imbalance ```

Question 34

What are the symptoms of DKA?

Answer 34

``` Polyuria Polydipsia Nausea and vomiting Acetone smell on breath dehydration leading to hypotension Altered conciousnes ```

Question 35

How is a case of DKA managed?

Answer 35

Fluid resuscitation Insulin infusion Monitor potassium and ketones and correct if necessary.

Question 36

What happens if injections are always in the same site?

Answer 36

lipodystrophy - subcutaneous fat hardens meaning insulin isn't absorbed properly

Question 37

What are the symptoms of hypoglycaemia?

Answer 37

``` Tremor Sweating Irritability Dizziness Pallor Decreased conciousness ```

Question 38

What are the macrovascular complications of diabetes?

Answer 38

Coronary artery disease = MI Stroke Hypertension Peripheral ischaemia = poor healing = diabetic foot and ulcers

Question 39

What are the microvascular complications of diabetes?

Answer 39

Peripheral neuropathy Retinopathy Kidney disease (glomerulosclerosis)

Question 40

How is diabetes monitored?

Answer 40

HbA1c - every 3-6 months | Capillary blood glucose

Question 41

How is type 1 diabetes managed?

Answer 41

Insulin regime involving multiple injections subcutaneously Monitor dietary intake of carbohydrates Monitor blood glucose levels