Diabetes Clinical Demonstration Flashcards

1
Q

What is carbohydrate

  • stored as
  • circulates as
  • metabolised as
A
  • Stored as glycogen
  • Circulating as glucose
  • Metabolised as glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is lipids

  • stored as
  • circulates as
  • metabolised as
A
  • Stored as triglyceride
  • Circulates as Non-esterfified fatty acids (NEFA), ketones, triglyceride
  • Metabolised as NEFA, ketones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the most important fact that causes the switch between using glucose and lipids as an energy source

A
  • insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the energy supply mostly derived from when you are in the fasting state

A

• Most energy supply coming from lipid oxidation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

is insulin high or low in the fasting state and what is the plasma glucose level

A

low insulin

- normal plasma glucose is 5 mmolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe what is being metabolised in the fasting state

A
  • No glucose being stored, glucose being mobilised from glycogen
  • Glucose being metabolised by brain, red blood cells & skin
  • High plasma fatty acids being oxidised by most other tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is activated in the fasting state

A

• Some ‘stress’ (hormones e.g. cortisol & sympathetic) – increase with prolonged fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when is the fed state

A

1-2 hours after a meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where is the most energy supply coming from in the fed state

A

• Most energy supply coming from glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

is insulin high or low in the fed state and what is the plasma glucose like

A
  • High insulin

* Plasma glucose 7-8 mmolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe what happens to glucose and fatty metabolism for insulin

A
  • Most glucose being stored as glycogen (but oxidation also increases)
  • Low fatty acids
  • Glucose being taken up by skeletal muscle (& metabolised by brain, red blood cells, skin as before)
  • Low stress hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how is increased fuel met when you need it in exercise

A

• Increased fuel needs met by increased oxidation of both lipid and glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is insulin and plasma level in glucose

A
  • Low insulin

* Normal plasma glucose 5 mmolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is metabolised in exercise

A
  • No glucose being stored, glucose being mobilised from glycogen
  • High fatty acids
  • Glucose being metabolised by skeletal muscle, brain, red blood cells, skin & others.
  • Aerobic & anaerobic .
  • High ‘stress’ hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does ketoacdisois happen

A
  • Ketone bodies of keto acids caused when you release fatty acids but don’t oxidise them completely
  • Get partial oxidation and ketone bodies build up
  • Get ketoacidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What fuels are used in the brain

A

• Brain, glucose under all conditions. Aerobic only. (ketones during starvation only)

17
Q

what fuels does red blood cells and skin use

A

• RBC & skin anaerobic glucose only

18
Q

what fuels does skeletal muscle use

A

• Skeletal muscle (cardiac muscle similar) – this can change
– Resting state, mostly fatty acids,
– Exercise state, mostly fatty acids (but glucose oxidation increases too)
– Fed state, glucose
(can do both aerobic & anaerobic)

19
Q

How much insulin is produced per day

A

• About 30 units of insulin per day

20
Q

what causes an increase in insulin requirement

A

• Insulin requirement increased in obesity or couch potatoes, less in active, fit people

21
Q

What is the percentage of beta cell function left in diabetes

A

• Diabetes always <30% of beta-cell function left, Type 1 usually about 10% when they present, usually <5% in most patients

22
Q

what is type 1 diabetes

A
  • autoimmune condition in which insulin is completely deficient and is not really present
  • it is absolute
23
Q

what is type 2 diabetes

A
  • a condition in which insulin is deficiency or there is a resistance to insulin
    i. e. may still be making 40 units per day, but need more
  • it is relative
24
Q

what causes type 1 diabetes

A
  • Autoimmune destruction of beta-cells in islets of Langerhans in pancreas
  • Familial, some genetics sorted out (cell surface antigens & immune response elements)
25
Q

what is the age group where type 1 diabetes is diagnosed

A

• Any age, most common about 7-13 years

26
Q

what is the prevalence of diabetes in the caucasian population

A

• Prevalence 0.2 of caucasian population (increasing recently)

27
Q

what is the presentation of type 1 diabetes

A
  • Younger
  • More suddnely – type 1 30% present as emergency, less than 5% for type 2s prevent as emergency
  • More weight loss – much more a feature of type 1
  • Polyuria
  • Increased thirst
  • Increase hunger
  • Never have diabetic tissue damage at presentation
28
Q

what are the differences between type 1 and type 2 diabetes

A
  • Younger than type 2 diabetes
  • More suddnely – type 1 30% present as emergency, less than 5% for type 2s prevent as emergency
  • More weight loss – much more a feature of type 1
  • Never have diabetic tissue damage at presentation – because it comes on suddenely but because type 2 have had high sugars for a long time before it is spotted they have damage from the high blood pressure
29
Q

Name the day to day management of type 1 diabetes

A
  • Monitor blood glucose level
  • Replace insulin
  • Eat regularly, timing and quantities
  • Adapt to changes in exercise, food and other illnesses/stress
30
Q

How can you work out your glucose

A
  • glucose monitoring system - abbots freestyle libre
  • have a sensory application and sensory pack, uses the sensor pack and get a blood prick and then place this in the machine and it measures it on the reader
  • can also get an app and sensor to do this
31
Q

what are the two types of hypoglycaemic symptoms

A
  • neuroglycopaenia

- sympathetic response

32
Q

what are the neuroglycopaenia symptoms of hypoglycaemia

A

Dizziness, visual disturbance, hunger
Confusion, personality change, aggression, goes quiet
Coma

33
Q

what is the sympathetic response symptoms of hypoglycaemia

A

Sweating, pallor, tremor, nausea

34
Q

what are the symptoms of high blood sugar

A

Just high blood sugar without acidosis or ketosis
thirsty, polyuria, nocturia, nausea
tired, infections

35
Q

what are the asymptomatic factors of high blood sugar (things that do happen but you don’t get symptoms for)

A

Renal & eye problems – specific to diabetes
Nerve problems – almost unique to diabetes
Blood vessel damage – similar to other atherosclerosis

36
Q

how does long acting insulin work

A
  • this is supposed to give insulin throughout the day and try to mimic real insulin
  • e.g. Levemir lasts 24 hours
37
Q

how does short acting insulin work

A
  • given just 15 minutes before a meal,
  • half life of 2 hours
  • e.g. Humalog
38
Q

Describe how insulin pump works

A
  • Insulin pump helps you to mimic pancreas
  • can choose how much insulin you give
  • chose when you give insulin - so for example it can give amount of insulin over several hours which is less damaging to the tissue than an insulin injection with a set amount at one time
  • change the site every 3 days - there is a reservoir compartment which will last about 3 days