Diabetes

Question 1

type 1 diabetes

Answer 1

insulin dependent (5-15%)

insulin deficiency and requires insulin treatment

can be due to viral damage to beta cells in pancreas

Question 2

type 2 diabetes

Answer 2

non-insulin dependent (85-95%)

disease of nutrient storage and insulin resistance

strongly linked with overweight/obesity

Question 2

diabetes

Answer 2

develops when glucose can’t enter body cells to be used as fuel

Question 3

diagnosis of diabetes

Answer 3

random venous plasma glucose >11.1mM (and 2 hour pp)

fast plasma glucose >7.0mM

Question 4

symptoms of diabetes

Answer 4

polyuria, polydipsia and unexplained weight loss

Question 5

HbA1c

Answer 5

measures extent that haemoglobin is glycosylated

good indicator of blood vessels to glucose

diabetes = HbA1c > or = 6.5%

Question 6

pre-diabetic

Answer 6

fasting plasma glucose <7.0mM

PP glucose >7.8mM but less than 11.1mM

Question 7

risk factors for T2DM

Answer 7

age 40-75 years, asian/african-caribbean origin, family history, poor diet, lack of exercise, overweight, given birth to large baby

Question 8

acute metabolic complications

Answer 8

hypoglycemia, DKA, non-ketotic hyperosmolar diabetic coma, lactic acidosis

Question 9

symptoms of hypoglycaemia

Answer 9

sweating, palpitations, trembling, shaking, confusion, irritability, slurred speech, difficulty concentrating, drowsiness, fatigue, weakness

Question 10

diabetic ketoacidosis (DKA)

Answer 10

gross insulin deficiency is predominant problem, most common in patients with type 1 diabetes

life threatening emergency

Question 11

DKA diagnosis

Answer 11

hyperglycaemia, low bicarbonate, low pH, ketonemia, moderate ketonuria

Question 12

hyperglycaemia

Answer 12

blood glucose levels >250mg/dL

Question 13

metabolic features of DKA

Answer 13

absolute insulin deficiency and counter-regulatory hormones promote lipolysis

shift in hepatic metabolism of incoming fatty acids due to high ratio of glucagon to insulin in portal flow

fatty acids oxidised to form ketone bodies

Question 14

symptoms of DKA

Answer 14

blurred vision, increased thirst, increased urination, nausea, vomiting, confusion, loss of consciousness

Question 15

signs of DKA

Answer 15

deep respirations, fruity breath, dehydration, hyperglycaemia, ketosis, acidosis

Question 16

treatment of DKA

Answer 16

give insulin in sufficient amount, attention to potassium levels and hydration

Question 17

hyperosmolar hyperglycemic state (HHS)

Answer 17

life threatening emergency that occurs in patients with type 2 diabetes, characterised by very high blood glucose without ketones

insulin secretion maintained to prevent peripheral lipolysis, liver able to metabolise FFA in non-ketogenic manner

relative insulin deficiency, hyperglycemia, hyperosmolarity

osmotic diuresis and volume, electrolyte depletion

Question 18

relative insulin deficiency

Answer 18

decreased peripheral uptake and increased heptatic gluconeogenesis

Question 19

hyperglycemia

Answer 19

blood glucose >600 mg/dL

Question 20

hyperosmolarity

Answer 20

plasma osmolarity >310 mOsm/L

Question 21

angiopathy

Answer 21

athersclerosis, hyaline atheriolosclerosis, diabeteic microangiopathy

Question 22

nephropathy

Answer 22

nodular glomerulosclerosis

Question 23

retinopathy

Answer 23

non proliferative and proliferative

Question 24

neuropathy

Answer 24

peripheral axonal neuropathy

Question 25

pathogenesis of microangiopathy

Answer 25

1. long standing diabetes 2. glycosylation of proteins 3. protein deposits in basement membrane 4. thick and leaky blood vessels 5. exudation and ischemia 6. end organ damage

Question 26

advanced glycation end products (AGEs)

Answer 26

proteins and lipids that become glycated as a result of exposure to sugars affect every type of cell in the body major factor in aging and age-related chronic disease

Question 27

impact of AGEs

Answer 27

increase vascular permeability, increase arterial stiffness, inhibit vascular dilation by interfering with nitric oxide, oxidise LDL, bind cells, enhance oxidative stress

Question 28

treatment of diabetes

Answer 28

step up approach starting with diet and lifestyle changes and working way up to exclusively insulin

Question 29

targets in T2DM

Answer 29

HbA1c 6.5% (or 7.5% if on drugs associated with hypoglycaemia) individualised HbA1c target of 7.5% or more if older, risk of hypoglycaemia, unlikely to achieve long term risk reduction benefit or multiple comorbidities

Question 30

diabetes management recommendations

Answer 30

- ADA, EASD, diabetes UK, IDF individualised care, target HbA1c = 48 - BP 140/80 (unless complication) - lipids TC<4, LDLC<3, TG<2, HDL>1 - albumin to creatine ratio check annually - creatinine yearly check, if abnormal check calcium and PTH - yearly eye check, yearly feet checked (unless neuropathy - regular) - yearly thyroid function test - pre conception advice to women in productive year, effective contraception and pre-pregnancy counselling (folic acid) - aspirin not primary prevention

Question 31

medical nutrition therapy for diabetes

Answer 31

- weight management - dietary patterns (ADG, meditteranean, vegetarian etc.) - CHO intake (even distribution to improve glycaemic control) - glycemic index (Low GI foods) - hypocaloric and non-nutritive sweeteners - protein, fat and alcohol intake (CVD risk) - physical exercise (decreases insulin resistance)

Question 32

diabetic remission

Answer 32

reversal dietary bsaed, no medication hypothesised that substantial weight loss in people with T2DM will improve insulin action and normalise overnight blood sugar, and normalise insulin response to eating more 15kg weight loss associated with 75% remission