DM

Question 1

what are the characteristics only associated with type II diabetes?

Answer 1

> 30 yrs old (60yrs = peak), obesity, family history, complications (long term) gradual onset, osmotic symptoms, no ketones in urine, high HbA1c

Question 2

what are the characteristics only associated with type II diabetes?

Answer 2

> 30 yrs old (60yrs = peak), obesity, family history, complications (long term) gradual onset, osmotic symptoms, no ketones in urine, high HbA1c

Question 3

what are the characteristics only associated with type I diabetes?

Question 4

where is type II diabetes more common?

Answer 4

Asia, Africa, Carribean

Question 5

where is type I diabetes more common?

Answer 5

Northern Europe

Question 6

what are the symptoms of diabetes?

Answer 6

polyuria and polydypsia (osmotic diuresis)
thrush (puritis vulvae and balaritis)
gunger?
blurred vision (glycated lens proteins)
fatigue (impaired use of glucose)

Question 7

what is the cause of type I diabetes?

Answer 7

pancreatic b cell destruction so insufficient insulin produced, autoimmune

Question 8

what is the cause of type II diabetes?

Answer 8

insulin resistance of tissues - impaired cellular response to insulin: receptor down-regulation, reduced signalling

Question 9

what is latent autoimmune diabetes in adults?

Answer 9

onset 40-60 years of type 1 diabetes develops more slowly

Question 10

what is mature onset diabetes of the young?

Answer 10

early onset of type 2 diabetes no insulin autosomal dominant

Question 11

what is gestational diabetes and what does it increase the risk of in later life?

Answer 11

diabetes during pregnancy increases the risk of getting type 2 later in life

Question 12

why might diabetes occur secondary to another condition?

Answer 12

pancreatic obstruction, cushings, acromegaly

Question 13

2 of which 3 symptoms are needed in order to diagnose type 1 diabetes?

Answer 13

weight loss
severe symptoms for short history
ketones in urine

Question 14

2 of which 3 symptoms are needed in order to diagnose type 1 diabetes?

Answer 14

weight loss
severe symptoms for short history
ketones in urine

Question 15

what are the characteristics only associated with type I diabetes?

Question 16

where is type II diabetes more common?

Answer 16

Asia, Africa, Carribean

Question 17

where is type I diabetes more common?

Answer 17

Northern Europe

Question 18

what are the symptoms of diabetes?

Answer 18

polyuria and polydypsia (osmotic diuresis)
thrush (puritis vulvae and balaritis)
gunger?
blurred vision (glycated lens proteins)
fatigue (impaired use of glucose)

Question 19

what is the cause of type I diabetes?

Answer 19

pancreatic b cell destruction so insufficient insulin produced, autoimmune

Question 20

what is the cause of type II diabetes?

Answer 20

insulin resistance of tissues - impaired cellular response to insulin: receptor down-regulation, reduced signalling

Question 21

what is latent autoimmune diabetes in adults?

Answer 21

onset 40-60 years of type 1 diabetes develops more slowly

Question 22

what is mature onset diabetes of the young?

Answer 22

early onset of type 2 diabetes no insulin autosomal dominant

Question 23

what is gestational diabetes and what does it increase the risk of in later life?

Answer 23

diabetes during pregnancy increases the risk of getting type 2 later in life

Question 24

why might diabetes occur secondary to another condition?

Answer 24

pancreatic obstruction, cushings, acromegaly

Question 25

which type of diabetes has ketones in the urine?

Answer 25

type 1

Question 26

2 of which 3 symptoms are needed in order to diagnose type 1 diabetes?

Answer 26

weight loss severe symptoms for short history ketones in urine

Question 27

what must random plasma glucose levels be with symptoms to diagmnose DM?

Answer 27

>11mmolo/l

Question 28

what must random plasma glucose be on 2 occassions without symptoms in order to diagnose DM?

Answer 28

>11mmol/l

Question 29

what must fasting plasma glucose be greater than with symptoms to diagnose DM?

Answer 29

>7mmol/l

Question 30

what must GTT - glucose tolerance test - (75g) be at fasting and after 2 hours in order to diagnosis diabetes without symptoms?

Answer 30

after fasty >7mmol/l after 2 hours >11mmol/l

Question 31

what must HBA1c be greater than in order to diagnose diabetes?

Answer 31

>48mmol/l

Question 32

when is HBA1c unsuitable to diagnose diabetes?

Answer 32

stress hyperglycaemia, children and young adults, DMT1 for less than 2 months, haemotological abnormalities affecting HBA1c, pregnancy, drug induced diabetes, symptoms less than 2 months

Question 33

what effect does insulin have on metabolsim?

Answer 33

signals fed state with lots of energy growth hormone promotes the use of energy for synthesis or storage

Question 34

name 5 processes promoted by insulin

Answer 34

glycolysis, protein synthesis, fatty acid synthesis, glucose uptake, glycogen synthesis

Question 35

how does insulin cause glucose uptake by cells?

Answer 35

binds to tyrosine kinase receptor --> PKB, P13K phosphorylate proteins --> GLUT4 inserted into membranes of insulin sensitive cells

Question 36

which reactions are promoted if insulin is low?

Answer 36

-ase enzymes are increased so things are broken down | gluconeogenesis, glycogenolysis, ketogenesis, lipolysis, proteolysis

Question 37

what does glucagon signal?

Answer 37

starvation so tries to increase plasma glucose levels for the brain

Question 38

what do very high levels of glucagon stimulate?

Answer 38

lipolysis, preteolysis

Question 39

which enzyme is responsible for breaking down lipids in the fasting state?

Answer 39

hormone senstive lipase breaks down adipose tissue into fatty acids

Question 40

why do diabetics have high blood glucose?

Answer 40

low insulin or tissues not responsive to insulin so GLUT4 not expressed so high glucose levels in blood gluconeogenesis and glycogenolysis stimulated producing more glucose, glycogen synthesis inhibited

Question 41

why do diabetics have glucose in their urine?

Answer 41

high plasma glucose exceeds the renal threshold

Question 42

why do diabetics have ketone body formation?

Answer 42

gluconeogenesis in the liver uses krebs cycle intermediates. accelerated fatty acid breakdown leads to more acetyl coA available XS acetyl coA can't be metabolised by krebs cycle so ketone bodies are formed instead

Question 43

what do diabetics have high HBA1c?

Answer 43

RBCs have a memory! glycated form of Hb covalkent bond between N-terminal of Valine and Hb index of average blood glucose concentration over the lifetime of Hb

Question 44

what sort of acidosis do diabetics have and what compensation occurs?

Answer 44

metabolic acidosis, respiratory compensation to decrease co2

Question 45

what are the 4 main long term microvascular complications of DM?

Answer 45

retinopathy, nephropathy, neuropathy, lens damage

Question 46

why does retinopathy occur?

Answer 46

basement membrane of capillaries damaged so increased permeability of capillaries leads to small haemorrhages in the eye

Question 47

how does hyerglycaemia and fluctuating insulin affect minor metabolic pathways?

Answer 47

increased use of minor metabolic pathways such as POLYOL pathway producing sorbitol and fructose that are osmotically active so lead to swelling

Question 48

what sort of proteins could be glycated in DM?

Answer 48

basement membrane, HBA1c

Question 49

why does lens damage occur in DM?

Answer 49

glycation of proteins in the lens --> cataracts | osmotic changes due to sorbitol from polyol pathway

Question 50

why does neuropathy occur?

Answer 50

demyelination of neurones due to blood vessel damage and sorbitol accumulation so decreased sensitivity and do not feel damage (loss of sensory perception) vascular degeneration decreses healing so ulcers and infection can occur

Question 51

why does nephropathy occur?

Answer 51

thickening of the basement membrane, disrupted filtering ability so leakage of large molecules

Question 52

at what level of glucose in the blood does coma and seizures occur?

Answer 52

1mmol/l

Question 53

how much higher is the risk of CHD?

Answer 53

2-3x

Question 54

why is there an increase in circulating LDLs in DM?

Answer 54

glycated LDLs and receptors reduces uptake so more in blood

Question 55

what can increased levels of LDL lead to?

Answer 55

LDL --> arteriole endothelium --> atherosclerosis

Question 56

why is there a danger of stasis in DM?

Answer 56

glycation of proteins in capillary membrane

Question 57

why are there higher ciculating levels of fatty acids?

Answer 57

xs lipolysis

Question 58

what are the treatments for retinopathy?

Answer 58

regular eye tests, laser treatment

Question 59

what are the negatives of tight glucose control?

Answer 59

increased risk of hypoglycaemia

Question 60

how can nephropathy be prevented?

Answer 60

urine test for microalbumin = very early sign | U+Es

Question 61

what is the important triangle?

Answer 61

lower blood glucose (control it), limit glucose variability, avoid hypoglycaemia

Question 62

what is the treatment for DMT2?

Answer 62

insulin 2 x daily mixture short/ mild acting insulin basal bolus 1 or 2x daily and pre meal

Question 63

what must DMT2 patients taking insulin be aware of?

Answer 63

judging CHO intake | awareness of blood glucose being lowered by exercise

Question 64

at what level of glucose in the blood does irreversible brain damage occur?

Question 65

at what level of glucose in the blood does coma and seizures occur?

Answer 65

1mmol/l

Question 66

what are the autonomic consequences of hypoglycaemia?

Answer 66

nausea, sweating, tremor, tachycardia, pallor, anxiety

Question 67

what are the neuroglycogenic symptoms of hypoglycaemia?

Answer 67

slurred speech, confusion, lethargy, coma, drowsiness, aggression, lack of concentration

Question 68

what is the blood glucose target for before meals?

Answer 68

4-7nM

Question 69

what is the blood glucose target for after meals?

Question 70

what is the target HBA1c?

Question 71

what are the positives of tight glucose control?

Answer 71

decreased risk of complications

Question 72

what are the negatives of tight glucose control?

Answer 72

increased risk of hypoglycaemia

Question 73

what 2 things should reverse DMT2 if substancial?

Answer 73

weight loss and exercise

Question 74

which medication can be used for DMT2?

Answer 74

hypoglycaemic agents to prevent complications

Question 75

where does metformin act and what does it do?

Answer 75

liver - inhibits gluconeogenesis

Question 76

whwre do a-gl;ucosidae inhibitors act?

Answer 76

inhibit glucose absorption in the stomach but not used because of flatulence

Question 77

how do glifoxins work?

Answer 77

increase glucose loss from the kidneys and decrease reabsorption leading to weight loss. -ve = UTIs

Question 78

how do sulphonylureas work?

Answer 78

increase insulin secretion from the pancreas

Question 79

WHERE DOES glp-1 ACT AND WHAT DOES IT DO?

Answer 79

GLUCAGON LIKE PEPTIDE 1 CAUSES PANCREASE TO PRODUCE INSULIN SO YOU FELL FULL

Question 80

HOW DO glp-1 ANALOGUES ACT?

Answer 80

like GLP-1 they increase insulin production from the liver so you decrease sugar and lose weight

Question 81

where does pioglitazone act?

Answer 81

liver, muscle, adipose increases insulin sensitivity but too many side effects so not used