Diabetes

Question 1

What is DM and the difference between type 1 and type 2?

Answer 1

DM is complex disturbance of metabolism due to lack of insulin production or a loss of receptor function.
Type1 - characterised by insulin deficiency or total lack off.
Type 2 - presents as a result of insulin resistance where the insulin receptor become insensitive.

Question 1

After a meal, how long does it take for glucose levels to increase?
When does blood glucose levels peak?
When does it return to normal?

Answer 1

Increase immediately after a meal.
Peaks in 3-5mins
Return to normal 2-3 hours.

Question 2

Facilitation of glucose uptake and usage by cells is one function of insulin in the body. There are five others, what are they?

Answer 2

Increasing glycogen synthesis and decreasing gluconeogenesis.
Increasing accumulation of fatty acids into adipose cells -lipogenesis.
Decreases ketogenesis.
Increasing protein synthesis and decreasing protein breakdown.
Moves potassium and phosphates into cells.

Question 3

Is the function of insulin anabolic?

Answer 3

True.

Question 4

True or false. All cells in the body need insulin to get glucose into the cell.

Answer 4

False, as beta cells, RBC and neurons do not insulin.

Question 5

The insulin receptors on the cell membranes of hepatocytes are called?
a. Glut1
b. Glut2
c. Glut3
d. Glut4

Answer 5

D - Glut4- found on liver and somatic cells.

Question 6

Which of the cells in the Islets of Langerhans in the pancreas are sensitive to hypoglycaemia?
a. beta cells
b. alpha cells.
c. delta cells.
d. gamma cells

Answer 6

Alpha cells - secrete glucagon.

Question 7

What are three methods of administration for insulin?

Answer 7

SC / IV / Parenterally

Question 8

Insulin can be classified based on the time it takes have an effect. What are 4 classifications of insulin and name one that goes with each?

Answer 8

Ultra short acting - Humalog, Novorapid
Short acting - Actrapid, Humilin
Intermediate acting - Humulin NPH, protophane
Long acting - ultratard, lantus

Question 9

Why can insulin not be given orally?
a. salivary amylase will digest insulin.
b. gastric acid and enzymes destroys insulin.
c. insulin cannot be absorbed in the small intestine.
d. insulin will be metabolised by the liver.

Answer 9

Gastric acid and enzymes destroys insulin - protein digesting enzymes destroy insulin.

Question 10

Why can patients with type 1 DM not be treated with oral hypoglycaemic drugs?
a. hypoglycaemic drugs do not replace insulin.
b. in type 1 DM the pancrease must be stimulated to make insulin.
c. the BGL fluctuate to much to be controlled by oral drugs.

Answer 10

The hypoglycaemic drugs do not replace insulin.

Question 11

How do we achieve the fastest rate of absorption of insulin?

Answer 11

If insulin is injected into the abdomen.

Question 12

What molecule can you add to insulin to delay the onset of action?

Answer 12

A protein called protamine to the insulin molecule delays the onset of action and duration.

Question 13

How is insulin transported in the body?

Answer 13

Through the blood after absorption.

Question 14

Where is insulin metabolised?

Answer 14

In the liver, by breaking the bonds between A & B chains and then breaking them down further. Only 30-40% of the exogenous insulin is cleared by the liver.

Question 15

What organ excretes insulin, and how much is excreted?

Answer 15

Around 60% of insulin is excreted by the kidneys.

Question 16

Lipodystrophy is one minor side effect of insulin. What are two others?

Answer 16

Weight gain.
Infection at injection site.

Question 17

Hypoglycaemia is one major effect of insulin. What are three others?

Answer 17

Insulin resistance
Allergic reaction
Hypokalaemia

Question 18

Hypokalaemia may occur as a result of insulin therapy because?
a. insulin destroys potassium.
b. potassium moves into the cells together with glucose.
c. BGL have an inverse relationship with potassium levels.
d. potassium is required to breakdown insulin.

Answer 18

Potassium moves into the cells with glucose.

Question 19

How much insulin does the pancreas release per a day to maintain normal BGL?

Answer 19

Around 50units of insulin.

Question 20

Where should we store insulin?

Answer 20

In the fridge as it a protein.

Question 21

What is the difference in colour between insulin that is fast acting or has a delayed onset of action?

Answer 21

Fast acting - clear
Delayed onset of action - cloudy?

Question 22

Do we use insulin in an IV that is cloudy?

Answer 22

No, it must be clear.

Question 23

What parameters of a person influences the dose of insulin?

Answer 23

Persons weight, age, diet and lifestyle.

Question 24

Where can you administer Insulin that is injected via SC injection?

Answer 24

Into abdomen, thighs, upper arms or buttocks - avoid veins.

Question 25

What is the reason for rotating the injection site? a. fluctuations in absorption rates. b. lipodystrophy c. micovascular disease at the injection site. d. developing resistance to insulin

Answer 25

Lipodystrophy - is a disorder of the adipose tissue - complications of SC insulin injections and occurs because of repeated injections at the same site.

Question 26

True or false. Giving a bolus dose of insulin with a meal mimics the body's natural rhythm of insulin release.

Answer 26

True. Endogenous insulin levels increase immediately after eating.

Question 27

why is insulin given through IV in emergency situations? a. higher doses can be given b. there are less side effects. c. the onset of action is faster. d. easier to adminster

Answer 27

The onset of action is faster.

Question 28

True or false. In older patients, the risk of hypoglycaemia is higher with the use of long acting insulin that with shorter acting preparations?

Answer 28

True.

Question 29

What are some drugs that increase BGL?

Answer 29

Beta2 agonists Atypical antipsychotics Triglyceride antidepressants Glucocorticosteroids Oral contraceptives Thiazide diuretics Thyroid and growth hormone

Question 30

What are some foods that increase BGL?

Answer 30

Processed foods White rice, bread and pasta Sugary drinks maple syrup honey

Question 31

What are some drugs that decrease BGLs?

Answer 31

Alcohol ACE Inhibitors Monoamine oxidase inhibitors high doses salicylates Dyrsrhythmic drugs anabolic steroids sulfonamides

Question 32

What are diagnostic tools for diabetes?

Answer 32

Random BGL of greater that 11.1mmol/L. Fasting plasma glucose of >7 glycated haemoglobin (hbA1c) ?55mmol/L Oral glucose tolerance test

Question 33

What is HbA1c?

Answer 33

Glycated haemoglobin. It measures the amount of BG attachd to haemoglobin. This shows your average blood glucose over the last 3mths. Normal 40mmol/mol or below. Pre diabetes 41-49 Diabetes 50 or above

Question 34

Explain type 1 Dm pathophysiology?

Answer 34

caused by an autoimmune response to the beta cells of the pancreas, resulting in total loss of insulin production. If there is not enough insulin in the body, the glucose in the blood cannot enter the cells = results in hyperglycaemia.

Question 35

Why is there gluconeogenesis in the presence of hyperglycaemia in patients with DM?

Answer 35

Starving liver cells switch to gluconeogenesis as an energy source for metabolism.

Question 36

What is the pathophysiology of T2DM

Answer 36

Condition in which the cells develop an insulin resistance and therefore cannot uptake glucose into the cells. This would lead to hyperinsulinemia.

Question 37

Why would diabetics experience polyuria

Answer 37

Due to glucose induced osmotic diuresis due to being hyperglycaemic. Osmotic diuresis it the increased urination due to the presence of certain substances in the fluid filtered by the kidneys. The process of osmosis created by these substances cause additional water to come into urine, increasing its amount.

Question 38

Why do diabetics have impaired wound healing

Answer 38

Circulation of blood at the wound site it critical for wound healing. Diabetics can have damaged blood vessels due to excess blood glucose levels. This decreases elasticity of the blood vessels and causes them to narrow, impeding blood flow. This reduces the supply of blood and therefore less oxygen can reach the wound and the tissues cant heal as quickly.

Question 39

Why do diabetics experience polydipsia

Answer 39

Caused by loss in fluid therefore thirst response is activated.

Question 40

Why do diabetics experience polyphagia

Answer 40

The body cells are starving as they are unable to absorb glucose from the blood, therefore hunger is increased.

Question 41

What is an example of macrovascular damage by high blood glucose?

Answer 41

Atherosclerosis resulting in hypertension, MI or decreased cerebral perfusion. Decreased immune responses impeding wound healing.

Question 42

Why would SOB indicate persistent hyperglycaemia in an acute presentation of a patient with T1DM

Answer 42

T1DM pts cannot synthesis insulin. If Their BGL’s remain high for too long without insulin, the cells become starved. The liver will metabolize fats for energy, with acidic ketones being a by-product. This would cause DKA. There would be respiratory compensation to try and restore normal pH and resp rate would increase.

Question 43

What are Kassmaul breaths

Answer 43

Rapid and deep breaths that indicate metabolic acidosis.

Question 44

Why would a milky drink not be used to treat hypoglycaemia

Answer 44

Fats would slow the metabolism of the sugars in milk. Lower fat content milk would raise BGL’s faster.

Question 45

What is the pathophysiology of diabetic ketoacidosis

Answer 45

When someone is hyperglycaemic, the cells are not receiving an adequate fuel source to produce energy and go into starvation mode. This triggers The liver to metabolize fats for energy where Ketones are released as a by-product of fat being catabolised. Ketones are acidic therefore when they build-up in the blood it leads to a metabolic acidosis called diabetic ketoacidosis.