Diabetes

Question 1

Which cells in the pancreas secrete insulin?

Answer 1

Beta cells in the pancreas secrete insulin.

Question 2

Which cells in the pancreas secrete glucagon?

Answer 2

Alpha cells in the pancreas secrete glucagon.

Question 3

What is the target range for blood glucose levels?

Answer 3

The target range for blood glucose levels is between 4-7 mmol/L, although ranges may vary.

Question 4

Where does glucose homeostasis predominantly occur?

Answer 4

Glucose homeostasis predominantly occurs in the liver.

Question 5

How is glucose stored and released in the liver?

Answer 5

Glucose is stored as glycogen in the liver and released into the circulation between meals.

Question 6

What does insulin do in glucose homeostasis?

Answer 6

Insulin suppresses gluconeogenesis (production of glucose) and facilitates the uptake of glucose

Question 7

What does glucagon do in glucose homeostasis?

Answer 7

Glucagon has the opposite effect of insulin. It promotes gluconeogenesis and raises blood glucose levels.

Question 8

What is the relative insulin-to-glucagon ratio in the fed state?

Answer 8

In the fed state, the insulin-to-glucagon ratio is high (high insulin:glucagon)

Question 9

What is the relative insulin-to-glucagon ratio in the fasting state?

Answer 9

In the fasting state, the insulin-to-glucagon ratio is low (low insulin:glucagon).

Question 10

How is hypoglycaemia defined?

Answer 10

Hypoglycaemia is defined as blood glucose levels below 3.5mmol/L.

Question 11

What are the symptoms of hypoglycaemia?

Answer 11

Symptoms of hypoglycaemia include sweating, tremor, nervousness, palpitations, and hunger due to the release of counter-regulatory hormones such as adrenaline and glucagon.

Question 12

What are the neuroglycopenic symptoms associated with hypoglycaemia?

Answer 12

Neuroglycopenic symptoms of hypoglycaemia include confusion, drowsiness, slurred speech, poor coordination, irritability (anger), and seizures. These symptoms occur due to the lack of glucose supply to the brain.

Question 13

Who is prone to hypoglycaemic unawareness?

Answer 13

Insulin-dependent diabetics are prone to hypoglycaemic unawareness.

Question 14

What are some causes of hypoglycaemia?

Answer 14

Causes of hypoglycaemia include insulinoma (an insulin-producing tumor in the pancreas), hypoadrenalism (reduction of glucocorticoids), alcohol consumption, severe liver failure, and the use of insulin or sulphonylureas.

Question 15

What are the management options for hypoglycaemia?

Answer 15

The management options for hypoglycaemia include eating or drinking sugar, using Hypostop (a glucose gel), administering intravenous dextrose 20% (75mL), and administering intramuscular glucagon 1mg if intravenous access is not available.

Question 16

What is diabetes mellitus (DM)?

Answer 16

Diabetes mellitus is a condition characterized by the dysregulation of insulin and glucagon, resulting in problems controlling blood sugar levels.

Question 17

How do insulin and glucagon influence glucose transport into cells?

Answer 17

Insulin increases glucose absorption into cells and out of plasma, while glucagon raises blood glucose levels by promoting glycogen breakdown in the liver and upregulating gluconeogenesis.

Question 18

What happens when there is too little glucose in cells?

Answer 18

Insufficient glucose in cells leads to a reduction in carbohydrate metabolism and decreased ATP production.

Question 19

What percentage of diabetics have Type 1 DM, and what is the cause?

Answer 19

Approximately 10% of diabetics have Type 1 DM. It is caused by a type 4 hypersensitivity response, where T-cells attack the beta cells of the pancreas, leading to insufficient insulin production.

Question 20

What are the symptoms of Type 1 DM?

Answer 20

The lack of insulin in Type 1 DM causes glycosuria (glucose in the urine) and polyuria (increased urine production). It also leads to polydipsia (excessive thirst), weight loss due to catabolic mechanisms, and polyphagia (increased hunger). These symptoms typically develop over a 4-6 week period.

Question 21

Are autoantibodies and specific HLA genes associated with Type 1 DM?

Answer 21

Yes, autoantibodies can be detected in individuals with Type 1 DM. Additionally, specific HLA genes, such as HLA DR3 and DR4 on Chromosome 6, have been identified in some Type 1 diabetics. HLA genes code for cell surface membranes involved in the immune system.

Question 22

What are the ketone bodies generated during lipolysis in Diabetic Ketoacidosis (DKA)?

Answer 22

The ketone bodies generated during lipolysis in DKA are acetone, acetoacetate, and β-hydroxybutyrate.

Question 23

What is the consequence of the accumulation of ketone bodies in DKA?

Answer 23

The accumulation of ketone bodies results in metabolic acidosis, known as ketoacidosis, due to their acidic nature.

Question 24

How does the body respond to metabolic acidosis in DKA?

Answer 24

The body responds to metabolic acidosis in DKA through Kussmaul’s breathing, which is deep breathing aimed at removing CO2 from the blood to reduce acidity.

Question 25

How does acidosis and low insulin levels in DKA lead to hyperkalemia?

Answer 25

Acidosis and low insulin levels in DKA lead to hyperkalemia by altering both the H+/K+ and Na+/K+ cell membrane transport pumps. The resulting imbalance drives H+ into cells, which in turn drives K+ out of the cell.

Question 26

What can hyperkalemia in DKA potentially cause?

Answer 26

Hyperkalemia in DKA can lead to fatal cardiac arrhythmias, posing a serious threat to the patient's health.

Question 27

What are the common symptoms of Diabetic Ketoacidosis (DKA)?

Answer 27

DKA presents acutely with symptoms such as nausea, vomiting, fruity sweet breath (acetone odor), and confusion (due to cerebral edema caused by fluid shifts).

Question 28

What is the primary treatment for DKA?

Answer 28

The primary treatment for DKA is insulin administration.

Question 29

What is the role of IV fluids in DKA treatment?

Answer 29

IV fluids are used in DKA treatment to restore hydration and correct electrolyte imbalances.

Question 30

Why is the replacement of potassium (K+) important in DKA treatment?

Answer 30

Potassium replacement is crucial in DKA treatment because acidosis and insulin deficiency can lead to hyperkalemia initially, followed by intracellular potassium shifting, leading to hypokalemia.

Question 31

What percentage of diabetes mellitus cases does Type 2 diabetes mellitus (T2DM) account for?

Answer 31

T2DM accounts for approximately 90% of diabetes mellitus cases.

Question 32

What is the primary cause of insulin resistance in T2DM?

Answer 32

Insulin resistance in T2DM occurs at the cellular level. The exact mechanisms of insulin resistance are not fully understood, but it is believed to involve the action of inflammatory response proteins that inhibit insulin receptor substrate (IRS) action.

Question 33

How does insulin resistance affect AKT activity?

Answer 33

Insulin resistance and IRS inhibition lead to reduced AKT activity. AKT inhibition disrupts the ability to transport glucose effectively within cells.

Question 34

What are the contributing factors to the development of T2DM?

Answer 34

T2DM is associated with obesity, hypertension, and lack of exercise. Genetic factors are also believed to play a role.

Question 35

How does T2DM progress over time?

Answer 35

In T2DM, higher than normal insulin levels are initially produced by the pancreas in an attempt to normalize glucose levels. This leads to pancreatic β-cell hyperplasia. However, over time, the build-up of amylin in the beta cells causes damage, resulting in a decrease in insulin production. This leads to the development of hyperglycemia.

Question 36

What are the symptoms that develop over months in hyperglycemia secondary to Type 2 DM?

Answer 36

Polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (increased hunger) develop over months in hyperglycemia secondary to Type 2 DM.

Question 37

What occurs in hyperglycemia secondary to Type 2 DM instead of diabetic ketoacidosis (DKA)?

Answer 37

In cases where insulin is still produced by pancreatic β-cells, diabetic ketoacidosis (DKA) does not occur. Instead, Hyperosmolar Hyperglycemic State (HHS) can occur, characterized by extreme hyperosmolality and dehydration due to high blood glucose levels.

Question 38

How is diabetes diagnosed?

Answer 38

Diabetes can be diagnosed through various methods including a random blood sugar test, a raised fasting glucose test (after fasting for 8 hours), an oral glucose tolerance test (2 hours after a glucose load), and measuring HbA1c levels.

Question 39

What does HbA1c measure in the diagnosis of diabetes?

Answer 39

HbA1c (glycosylated hemoglobin) is measured to provide a time-averaged snapshot of blood glucose levels over the lifespan of red blood cells (approximately 120 days). It reflects the average blood glucose levels over a prolonged period.

Question 40

What is an oral glucose tolerance test used for in diabetes diagnosis?

Answer 40

An oral glucose tolerance test is conducted by measuring blood glucose levels 2 hours after consuming a glucose load. It helps evaluate the body's ability to regulate blood sugar levels.

Question 41

What are the primary methods of glucose control in Type 1 DM and Type 2 DM?

Answer 41

In Type 1 DM, insulin is the primary method of glucose control. In Type 2 DM, it can involve monotherapy (using a single drug) or combination therapy (using multiple drugs).

Question 42

What are the key monitoring methods for long-term glucose control?

Answer 42

Monitoring methods for long-term glucose control include measuring HbA1c levels and daily blood sugar measurements.

Question 43

What lifestyle factors are important in long-term diabetes management?

Answer 43

Lifestyle factors such as diet and exercise play a crucial role in long-term diabetes management.

Question 44

What are some commonly used types of insulin in different regimes?

Answer 44

Commonly used insulin types include rapid-acting insulin (e.g., Novorapid), short-acting insulin (e.g., Actrapid), long-acting insulin (e.g., Insulatard), and mixed insulin (a combination of short-acting or analogue insulin with long-acting insulin, e.g., Humulin M3).

Question 45

How are slow-acting and fast-acting insulins achieved at the molecular level?

Answer 45

Slow-acting insulin is achieved by increasing the time it takes for the insulin hexameric complex (inactive form) to dissociate into active monomers. This is achieved through mutation and/or modification. Fast-acting insulin, on the other hand, is achieved by mutations or the attachment of hydrocarbons that generate aggregates which slowly dissociate into monomers.

Question 46

What is the mechanism of action of metformin in the treatment of Type 2 DM?

Answer 46

Metformin, a biguanide, decreases glucose production in the liver and increases insulin sensitivity in tissues.