Diabetes

Question 1

What is Diabetes Mellitus?

Answer 1

A syndrome of chronic hyperglycaemia due to a relative insulin deficiency, resistance or both

Question 2

What should normal blood glucose levels be under all conditions?

Answer 2

3.5- 8.0mmol/L

Question 3

What is the principal organ of homeostasis?

Answer 3

The liver

Question 4

In what ways does the liver control glucose levels?

Answer 4

• Stores and absorbs it
• performs gluconeogensis
• performs glycogen’s if blood glucose is too high
• Lipogenesis

Question 5

What does the liver do if the blood glucose levels are too low?

Answer 5

Splits glycogen converting it to glucose in a process called gluconeogensis

Question 6

How much glucose if produced and utilised a day?

Answer 6

200g

Question 7

Which organ is the main consumer of glucose?

Answer 7

The brain

Question 8

Why can the brain now use free fatty acid conversion into ketone bodies for energy?

Answer 8

Free fatty acids can’t cross the BBB

Question 9

Is glucose uptake in the brain dependent on insulin?

Answer 9

No

Question 10

What is the function of insulin?

Answer 10

• Suppresses hepatic glucose output

- Increases glucose uptake into insulin sensitive cells

Question 11

What does biphasic insulin release mean?

Answer 11

First phase is rapid release when the b cells sense the rising glucose levels.

Second phase is if the levels remain high

Question 12

What does glucagon do?

Answer 12

• Increases hepatic glucose output
• Reduces peripheral glucose update
• Stimulates: Lipolysis and muscle glyconeolysis and breakdown

Question 13

What is C peptide?

Answer 13

It joins together the alpha and beta chains in proinsulin which is the precursor to insulin

Question 14

What happens in regards to C peptide when insulin is being produced?

Answer 14

There ends up being high levels of C peptide in the blood due to the fact that proinsulin is cleaved from its c peptide.

Question 15

After secretion where is insulin carried to?

Answer 15

The liver

Question 16

Briefly describe how glucose enters a cell?

Answer 16

It is carried through by a family of specialised glucose-transporter proteins that bind with the surface of the cell when activated by insulin.

Question 17

What are the two types of primary diabetes?

Answer 17

Type 1 and Type 2

Question 18

What conditions can diabetes be secondary to?

Answer 18

• Pancreatitis
• Trauma/pancreatectomy
• Neoplasia of pancreas
• Acromegaly
• Cushing syndrome
• Addisons
• Drugs

Question 19

What are the macro vascular complications associated with diabetes?

Answer 19

• Atherosclerosis

- Peripheral vascular disease

Question 20

What are some symptoms of peripheral vascular disease?

Answer 20

• Intermittent claudication

- Rest pain (pain when sleeping and having to walk around to get the blood flowing)

Question 21

What microvascular problems are associated with diabetes?

Answer 21

• Diabetic retinopathy
• Diabetic nephropathy
• Diabetic neuropathy
• Infections
• Diabetic foot ulceration

Question 22

What is seen in diabetic retinopathy?

Answer 22

• Microaneuryms

- Haemorrhages

Question 23

What is hallmark sign of diabetic nephropathy?

Answer 23

Proteinuria

Question 24

What happens in diabetic nephropathy?

Answer 24

Thickening of the basement membrane of the glomerulus due to poor glycemic control will lead the microalbuminuria

Question 25

How is microalbuminuria identified?

Answer 25

Urine albumin:creatinine ratio >3 -- a conventional dipstick won't work

Question 26

What is the main worry with nephrotic syndrome?

Answer 26

It may process to end stage kidney disease and dialysis might be required

Question 27

What is the commonest form of diabetic neuropathy?

Answer 27

Distal symmetrical 'glove and stocking'

Question 28

What are the features of diabetic neuropathy?

Answer 28

- Pain - Autonomic dysfunction e.g postural hypertension - Insensitivity e.g glove and stocking - can lead to food ulcerations - Amyotrophy - painful asymmetrical wasting of quads and diminished knee reflex - Mononeuritis - Isolated palsies mainly to extraoccular muscles

Question 29

What is the treatment for diabetic neuropathy?

Answer 29

- Good glycemic control and opioids for the pain

Question 30

How should diabetic neuropathy be managed?

Answer 30

Foot screening and teaching patients to care for their feet and check them everyday

Question 31

What is type 1 diabetes mellitus?

Answer 31

Disease of insulin deficiency usually caused by autoimmune destruction of beta cells of the pancreas

Question 32

What is the cause of type 1 diabetes?

Answer 32

Autoimmune - auto-antibodies forming against insulin and islet beta cells Some genetic susceptibility - HLA-DR3-DQ2 or HLA-DR4-DQ8

Question 33

Why are type 1 diabetics at risk of ketoacidosis?

Answer 33

Reduced glucose supply and so fatty acid oxidation is used for energy - this leads to ketone body production. These are acidic

Question 34

What effect does acidification have on the blood?

Answer 34

Impairs the ability of haemoglobin to bind to oxygen

Question 35

If a patient is in diabetic ketoacidosis what will their breath smell like?

Answer 35

Pear drops

Question 36

What serious side effects do you get in a patient who is in ketoacidosis?

Answer 36

- Excess fat breakdown leading to weight loss and anorexia - Dehydration leading to AKI - Hyperglycaemia

Question 37

What is diabetes mellitus type 2?

Answer 37

Results from a combination of insulin resistance and less severe insulin deficiency

Question 38

What is the brief pathophysiology of DMT2?

Answer 38

Hypersecretion of insulin by the beta cells in response to the cells being resistant to insulin hyperglycaemia and lipid excess are toxic to beta cells and thus there is deterioration of beta cells.This leads to a progression towards insulin deficiency which can then require insulin therapy

Question 39

Why don't type 2 diabetics develop ketoacidosis?

Answer 39

Due to the small amount of circulating insulin in the blood which can halt the breakdown of fat and muscle into ketones.