Diabetes L24

Question 1

What is diabetes mellitus

Answer 1

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

Question 2

What does insulin do

Answer 2

Insulin lowers blood glucose by supressing glycogenolysis and gluconeogenesis in the liver and stimulates glucose uptake into mainly skeletal muscle

Question 3

What is the normal glucose level limit

Answer 3

Blood glucose levels are normally maintained within narrow limits (3.5-8.0 mmol/l)

Question 4

How can diabetes be classified

Answer 4

Primary or secondary

Question 5

What is gestational diabetes

Answer 5

Diabetes that arises during pregnancy

Question 6

What classification does Type 1 and 2 come under

Answer 6

Primary diabetes

Question 7

What type diabetes is the majority of the UK

Answer 7

Type 2, with about 85% people having it

Question 8

Diabetes is prevalent in what ethnicities

Answer 8

South Asian and African

Question 9

What is type 1 diabetes

Answer 9

Insulin dependent diabetes, due to destruction of beta cells in the pancreas islets of Langerhans by autoimmune attack (which is triggered by genetic and environmental factors)

Question 10

What are the typical symptoms for type 1 diabetes

Answer 10

Excessive thirst, blurred vision, bedwetting, frequent urination, lack of energy, constant hunger and sudden weight loss

Question 11

Why is it difficult to distinguish between Type 1 and 2 in later years of life

Answer 11

Because presentation of both are quite similar

Question 12

When is Type 1 diabetes usually diagnosed

Answer 12

Between early ages of 10-15

Question 13

What is Type 2 diabetes

Answer 13

Non-insulin dependent diabetes where patients can survive without insulin for at least 6 months after diagnosis

Question 14

Why does Type 2 diabetes occur

Answer 14

Gradual reduction in insulin secretion or insulin resistance in tissues

Question 15

What is a diabetogenic lifestyle

Answer 15

Physical inactivity, high intake of saturated fat, obesity

Question 16

What is the routine diagnosis check for diabetes

Answer 16

When patients goes to see GP, venous plasma glucose is measured which if it is equal to or greater than 11.1 mmol/l, then they are considered to have diabetes. However, they ar called again to do a fasting glucose (8hrs), if it is more than or equal to 7 mmol/l. Then diabetes is diagnosed

Question 17

What is the alternate diagnosis for diabetes

Answer 17

HbA1c (glaciated haemoglobin) which measures the amount of glucose that is being carried by the red blood cells in the body and if it is above 6.5% (48mmol/mol) its indicative of Type 2 diabetes

Question 18

What is the treatment for Type 2 diabetes

Answer 18

1) Achieving glycaemic control
2) Healthy lifestyle (lose weight, stop smoking, appropriate exercise)
3) Control hypertension/ hyperlipidaemia

Question 19

How to achieve glycemic control

Answer 19

1) Diet
2) Oral hypoglycaemic agents
- Biguanides e.g. Metformin
- Sulphonylureas e.g. Glibenclamide
- Glitaziones e.g. Pioglitazone
3) Insulin

Question 20

What are the 4 broad types of insulin and about how long do they last

Answer 20

1) Short-acting insulin – Soluble insulin acts quickly and lasts for between 6 and 8 hours.
2) Intermediate-acting – Isophane insulin acts slightly slower and lasts for between 10 and 14 hours.
3) Long-acting insulin – These insulin types act slowly and last much longer (up to 24 hours)
4) Mixtures of insulin – Mixed short and intermediate-acting insulin

Question 21

Generally how many injections do Type 1 and 2 diabetics need to take

Answer 21

2x or 4x for Type 1 and once usually for Type 2

Question 22

How are diabetic control measured

Answer 22

Urine tests, blood glucose testing and glycosylated haemoglobin

Question 23

What is the benefit of self-monitoring blood glucose machines

Answer 23

Self-monitoring of blood glucose can aid glycaemic control

Question 24

How does flash glucose monitoring work

Answer 24

It is where a small sensor on the arm with a probe just under the skin and by ‘flashing’ the sensor with a scanning device, the user receives a blood glucose level reading and a graph of blood glucose levels for the previous eight hours

Question 25

How often are people with diabetes screened and what tests are conducted

Answer 25

Anually usually through BMI
BP, Eye examination, Foot examination, Blood tests (HbA1c, lipid profile, creatinine), Urine tests (proteinuria), Smoking status

Question 26

What are some of the ocular issues that can arise due to diabetes

Answer 26

Proliferative retinopathy
Retinal detachment
Maculopathy
Cataract
Rubeosis iridis

Question 27

What is diabetic neuropthy and what does it affect and damage

Answer 27

Disfunction of the peripheral nervous system and can affect sensory (mainly affect lower limbs) and the autonomic nervous system (causes damage to both sympathetic and parasympathetic nerves leading to gastrointestinal problems, incontinence and erectile dysfunction)

Question 28

Cranial nerve palsies are common in diabetic patients, however what do affect does it have

Answer 28

Nerves to the extra-ocular muscles are affected, loosing control of the eyeballs and can result in double vision also

Question 29

What are the complication that can arise in feet of diabetics and due what to what reasons

Answer 29

Neuropathy and ischaemia are the principal causes of foot ulceration and infection and sometimes also gangrene (may lead to amputation)

Question 30

Diabetes can affect the function of kidneys, how can this be confirmed and what can it lead to

Answer 30

Signs of proteinuria, if untreated proteinuria increases and glomerular filtration rate progressively declines with subsequent renal failure.

Question 31

How can kidney complications be managed in diabetics

Answer 31

Managed by ACE (angiotensin converting enzyme) inhibitors and strict hypertension

Question 32

What can be an issue later on in life for gestational diabetics

Answer 32

They may be predisposed to Type 2 diabetes later in life

Question 33

Pregnancy can exacerbate what issues in a diabetics

Answer 33

Retinopathy and nephropathy