Diabetes

Question 1

what is diabetes?

Answer 1

disorder of the metabolism causing excessive thirst and the production of large amounts of urine

Question 2

two categories of diabetes?

Answer 2

mellitus
insiupidus
same symptoms

Question 3

what is diabetes mellitus?

Answer 3

group of metabollic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

Question 4

types of diabetes?

Answer 4

type 1
type 2
MODY
gestational

Question 5

what is type one diabetes?

Answer 5

pancreatic beta cell destruction/insulin required for survival
= anti GAD, anti islet cell antibodies

Question 6

what is type two diabetes?

Answer 6

if patient does not have type one, monogenic or result of other medical condition/tx = secondary diabetes

Question 7

what are secondary causes of diabetes?

Answer 7

diabetes as a result of drugs
pancreatic pathology
endocrine cause

Question 8

when was insulin discovered?

Answer 8

1922 - banting, best, macleod, collip - discovered insulin. Removed pancreas of a dog - treatment by insulin injections

Question 9

when was the 1st diabetes patient treated with insulin?

Answer 9

1922 in toronto - 14yr old leonard thompson

Question 10

Type 2 diabetes caused by?

Answer 10

insulin resistance and beta cell function has core defects

Question 11

genetic susceptibility, obesity and western lifestyle lead to what that causes type 2 diabetes?

Answer 11

insulin resistance and beta cell dysfunction

Question 12

normally what happens to insulin?

Answer 12

insulin binds to a receptor triggering production of glucose transport proteins to allow glucose to enter cell q

Question 13

if someone is insulin resistance what happens?

Answer 13

receptor not as responsive to the binding insulin molecule, therefore there is less glucose entering the cell and a build up of glucose in the blood

Question 14

some causes of insulin resistance?

Answer 14

ectopic fat accumulation and increase in free fatty acids

increase in inflammatory mediators CRP

Question 15

the increase in free fatty acids and CRP mediators results in?

Answer 15

inhibition of insulin via serine kinases responsible for phosphorylation of insulin receptor substrate 1 (IRS1)
= reduction in insulin stimulated glycogen synthesis due to reduced glucose transport

Question 16

insulin resistance associated with?

Answer 16

intra abdominal obesity
inactivity
meds
genetics
smoking
fetal malmutrition
endothelial disease
aging
hypertension

Question 17

what is the therapy staircase for type 2 diabetes?

Answer 17

diet and exercise
oral monotherapy
oral combination
injectable and oral therapy

Question 18

lifestyle changes for type 2?

Answer 18

weight loss
smoking cessation
improve diet
exercise

Question 19

drugs to treat type 2?

Answer 19

metformin - biguanide
sulfonylureas
insulin

Question 20

considerations for drug choices in type 2?

Answer 20

duration of diabetes
degree of improvement required
mode of delivery 
adverse effects
pt preference
cost

Question 21

what is HbAIC?

Answer 21

measure of blood glucose over a prolonged period pf 6-8 weeks
ref range = 6.6-7.5%/ 48-58 mmol

Question 22

how to do home blood glucose monitoring?

Answer 22

target should be between 4 and 7 before meals and under 10 after meals

Question 23

reducing chronic complications allows?

Answer 23

avoidance of microvascular disease
avoidance of acute metabolic complications - DKA
reduced physiological morbidity

Question 24

macrovascular disease?

Answer 24

IHD, stroke

Question 25

microvascular disease?

Answer 25

neuropathy nephropathy retinopathy

Question 26

what is diabetes the leading cause of?

Answer 26

blindness dialysis amputation

Question 27

how to screen for microvascular complications?

Answer 27

- annual urinary albumin creatinin ratio ACR for diabetic kidney disease - annual retinal photograph - annual foot screening

Question 28

what is metabolic syndrome?

Answer 28

central obesity high bp high triglycerides - low hdl cholesterol insulin resistance

Question 29

how is cholesterol treated in diabetes?

Answer 29

lipid lowering statins in all diabetic patients over 40 regardless of baseline cholesterol

Question 30

ensure bp is what in a diabetic pt?

Question 31

aspirin and diabetes?

Answer 31

not recommended for primary prevention but may be used in secondary prevention if CVR >10% in 10 years

Question 32

what happens when glucose falls?

Answer 32

there is a release of counter regulatory hormones - glucagon, adrenaline and cortisol aim is to stimulate glycogenolysis side effects = sweats, palpitations, flushing

Question 33

symptoms of hypoglycaemia?

Answer 33

sweats, shakes, flushing, palpitations = autonomic | neuroglycopenic= confusion, reduced gcs, collapses, seizures, coma

Question 34

what happens with repeated exposures to hypo's?

Answer 34

a gradual reduction in warning signs progressive loss of counter regulatory hormone response = glucagon, adrenaline more likely to have neuroglycopenic symptoms

Question 35

precipitating factors for hypoglycaemia?

Answer 35

``` dosage of ohg/insulin errors in dose given timing of meds - esp insulin delay in meals exercise alcohol co morbidity - e.g renal insufficiency adrenal insufficiency pituitary insufficiency ```

Question 36

hyperglycaemia in type 1? type 2?

Answer 36

1 - diabetic ketoacidosis DKA | 2 - hypermolar non ketotic coma

Question 37

hyperglycaemic b/c?

Answer 37

``` acute illness co morbidity injury/infection meds poor compliance/errors in compliance with tx psychological or social issues ```

Question 38

in hyperglycaemia measure?

Answer 38

ketones acidosis need iv fluids and insulin

Question 39

increased risk of hypo/hyperglycaemia in emergency patients bc

Answer 39

poor oral intake sepsis sleep deprivation = modification of normal drug regime

Question 40

higher risk of perio disease in diabetic pt's because?

Answer 40

high glucose = poor healing and increased infection risk | small blood vessel damage = reduced blood flow

Question 41

increase BG monitoring when?

Answer 41

during acute illness

Question 42

what is the bg for a hypoglycaemic pt?

Question 43

what patients should ketone monitor?

Answer 43

type 1 diabetic patients

Question 44

what is being measured with a ketone monitor?

Answer 44

beta hydroxybutyrate

Question 45

what is the range for ketone monitoring?

Answer 45

0-8mmol/l

Question 46

what is the normal ketone measurement?

Question 47

insulin secreted at s low basal rate is responsible for how much of insulin produced?

Answer 47

50%

Question 48

post meal glucose stimulates?

Answer 48

post prandial insulin

Question 49

what types of insulin are available?

Answer 49

long acting short acting rapid acting

Question 50

how can insulin be administered?

Answer 50

syringe disposable pen reusable cartridge pen continuous subcutaneous insulin fusion pump

Question 51

what is a CSII?

Answer 51

``` for type 1 programmable infusion pump self managed pulsates alanouge insulin continuously bolus dose of insulin pumped out at mealtimes calculated on CHO content of food ```

Question 52

management of diabtes during illness?

Answer 52

increased monitoring | insulin increased b/c body response to stress

Question 53

what can corticosteroids precipitate?

Answer 53

hyperglycaemia