diabetes

Question 1

what type of reaction is type 1

Answer 1

delayed as T cells attack

Question 2

why do people loose 1 in type 1

Answer 2

essentially the cells are starving so they resort to other methods

Question 3

how does diabetes affect the stomach

Answer 3

patients have gastroperis, delayed gastric emptying so they complain of getting full early on and feeling nauseas and vommiting

Question 4

how does diabetes affect the RBCS

Answer 4

CBC: increased HTC( why) and also has shown increased viscosity of the blood as the morphology of rbc changes (shape, size)

Hypochromia – An anemia of the RBCs, observed as a paler than normal color, due to a reduction in haemoglobin which reduces oxygen affinity
Anisocytosis – RBCs in diabetics are unequal in size.
Poikilocytosis – Variations in RBC shape, with up to almost a third of red cells being unequal in size, compared to below 2% in non-diabetic patients.

rbc also have an increased diameter

Question 5

how does diabetes affect the liver

Answer 5

Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes.

Question 6

RF FOR TYPE 2

Answer 6

BMI >25kg/m2,
1
st degree relative with DM,
Arterial hypertension >140/90mmHg, PCOS
HDL <0.9mmol/l and/or TAG >2.2mmol/l
History of CVD
Polycystic ovarian syndrome

Question 7

VALUE range for random

Answer 7

11.1

Question 8

VALUE range for fasting

Answer 8

7

Question 9

prediabteic values

Answer 9

FPG 6.3-7.0 or 2hr oGTT 7.8-11.1

notes say for fating - 5.6-6.9

Question 10

normal hb a1c values

Answer 10

4- 6.2 % - lecture confirmed

Question 11

what’s important about hba1c

Answer 11

B HbA1C should not be used for dx if: Young pt (child) or is suspected of
having DM1, pregnancy, medications which cause hyperglycemia - steroids,
antipsychotic

Question 12

threshold for glycated

Answer 12

6.5%

Question 13

acute complications

Answer 13

hypoglycaemia, ketoacidosis, nonketotic

hyperosmolar coma

Question 14

what classes as hypoglycaemia for a person with diabetes vs a non diabetic

Answer 14

non diabetic - 2.8 mol

diabetic - 4mmol

Question 15

how does alcohol affect blood sugar levels

Answer 15

Alcohol makes your blood sugar levels drop by inhibiting the liver’s ability to release glucose. initially however it can cause a raised spike in levels

Question 16

factors of hypoglycaemia

Answer 16

too much insulin 
skipped a meal 
gastropareisis 
increases sensitivity  to insulin
clearance of insulin

Question 17

tx severe hypoglycaemia

Answer 17

or intramuscular Glucagon 1mg - wake up slice of bread long release

10% Glucose 200ml/hr if patient is conscious
10% Glucose at 200ml/15 mins if patient is unconscious

Question 18

triad of DKA

Answer 18

ketonuria /ketonemia
acidosis
hyperglycaemia

Question 19

definition of ketonemia in DKA

Answer 19

> 3 mmol

Question 20

normal osmalitty of blood

Answer 20

280-300

Question 21

smality values in DKA

Answer 21

> 350

Question 22

when to give bicarb

Answer 22

only in < рН6.9, give 100mmol 8.4%

sodium bicarbonate + 20mmol KCl are infused for 45 min.

Question 23

what’s the difference between non ketogenic and dka

Answer 23

there is hyperflycmeia >30 mol but no ketones

mortality is higher

PH is >7.3 (but occacionlay a mild acidosis can develop)

MARKED VOLUME DEPLETION

not as acute as DKA

more likely to see in elderly than young unlike in DKA

don’t give insulin unless dingifacnt changes?

Question 24

what sodium electrolyte is more likely in ska

Answer 24

hyponatremia is commonly seen ( vommiting, ) Dilutional hyponatremia is common due to water driven into the intravascular space from inside cells.

but hypernatremia can be too

Question 25

tx of HHS

Answer 25

LMWH - prevent clots rehydration with 0.9% saline correct hypoklameia only give insulin if ketonemia or only glucose is not falling by 5mmol/L/h with rehydration or if ketonemia is present

Question 26

microangiopathy examples

Answer 26

eyes and kidneys

Question 27

rubeuosis iridis

Answer 27

New vessel formation on iris - can lead to glaucoma cos they block the angle of the eye

Question 28

changes of kidney

Answer 28

``` glomerular hypertyophy mesangial proliferation hyalinosi s glomerular sceloris BM thickening ```

Question 29

advice for diabetics

Answer 29

stop smoking monitor bP - <130/80 mmHg with proteinuria fat levels . if you have proteinuria keep it lower control body weight keep BMI <25

Question 30

proliferative retinopathy

Answer 30

comes after non proliferative, more advanced and poorer outcome, associated with neovascurilisation but with fragile vessels, and so associated with vitreous hemroggabe + tractional retinal detachment due to fibrosis of vessels the vessels can also lead to glaucoma as they block the angle of the eye prevent draining

Question 31

how to manage a patient with macroalbuminera

Answer 31

1. keep blood pressure <125/75 2. antiaggrgants for thrombosis - peeign out antithrombin 3. reduce protein intake up to < 0.8g/kg body weight daily 4. EPO if HB less than 115

Question 32

type of macroangipathy

Answer 32

Coronary vascular disease 2. Cerebrovascular disease 3. Peripheral vascular disease

Question 33

RF for macroangipathy

Answer 33

``` Poor glycaemic control - HbA1c >6.5% Arterial hypertension Dyslipidaemia (↑LDL and ↓HDL) Obesity - Overweight BMI >25 Smoking ```

Question 34

examples of autonomic neuropathy

Answer 34

gastropareiss, fixed tachycardia, ED, retrograde ejaculation , urinary retention or incontenice, orthostatic hypotension (drops by more than 30) ,

Question 35

classification of diabetic neuropathy

Answer 35

autotomic | peripheral

Question 36

metabolic syndrome

Answer 36

when 3 of the 5 is diagnose d 1. diabtes 2. hypertension 3. low HDL and elevated LDL 4. elevated TAG 5. obesity

Question 37

dx of type 1

Answer 37

anemia | but also diabetes is often misdiagnosed as a UTI, strep throat or viral infections like infectious mono

Question 38

advice for gasttoprepris

Answer 38

avoid fatty foods, can take metoclorprmaide

Question 39

why is there s.o.b in dkah

Answer 39

ketones build up faster than the kidneys can remove them from the body. This results in a buildup of ketones, which is toxic. The body may try to use the lungs to expel the excess ketones, which causes shortness of breath

Question 40

diagnostic criteria for hhs

Answer 40

``` Severe hyperglycaemia >30mmol/L hyperosmolarty > 320mOsm/Kg – Normal pH >7.3 No ketonemia < 3mmol/L High blood sodium and urea aka Hypovolemic Hypernatremia: dehydration - relative increase in sodium Hypokalemia ```