Introduction to diabetes mellitus

Question 1

How does insulin act

Answer 1

Decreases hepatic glucose output - decreases gluconeogensis

Increase muscle uptake of glucose

Decrease proteolysis

Decreases lipolysis

Decrease ketogenesis

Question 2

Clinical Relevance of glucose

Answer 2

Type 1 diabetes

Hypoglycaemia

Insulin Resistance

Type 2 diabetes

Question 3

What is the GLUT-4 transporters

Answer 3

Common in myocytes (muscle) and adipocytes (Fat)

Highly insulin-responsive

Recruited and enhanced by insulin

Increase glucose uptake

Hydrophilic inside and hydrophobic outside

Question 4

Effects of insulin on cell metabolism

Answer 4

Insulin inhibits protein breakdown

Converts amino acids into protein - GH, IGF-1

Cortisol helps gluconeogenic aminoa cids transfer from myocyte to liver

Question 5

What happens in gluconeogensis

Answer 5

AA taken up by the liver - enhanced by glucagon

Insulin encourages AA to protein

Insulin gluconeogenesis

Glucagon and Cortisol encourages protein to AA and gluconeogensis

Question 6

How long to the fuel stores last

Answer 6

Carbs - 16hrs

Protein - 15 days

Fat - 30 to 40 days

Question 7

How are triglycerides broken down

Answer 7

Lipoprotein lipase break them down

Not esterified fatty acid

Insulin activates this enzyme

Glucose can also be taken up by adipocytes by GLUT-4

Insulin also converts gly and NEFA into triglycerides

Insulin inhibits triglycerides

Question 8

Where is insulin released

Answer 8

Hepatic protal circulation

Question 9

What does glycerol do in the liver

Answer 9

During fed state, it converts to triglycerides

It can be converted to glucose

Question 10

What is the cerebral energy requirement of the brain

Answer 10

Glucose (preferred

Keton bodies

No NEFA

Question 11

WHat does ketones bodies to in liver

Answer 11

NEFA enter the liver

Insulin inhibits conversion of fatty acyl-coA into ketone bodies

Question 12

What does glucose does in the liver

Answer 12

Hepatic glycogenolysis

Generation of glucose from stored glycogen in the liver

Question 13

What can muslce cells utilise as energy

Answer 13

NEFA

Glucose

Question 14

Can muscle cells release glucose into circulation

Answer 14

No

Question 15

What hormones and pathways happen in fasted state

Answer 15

Low insulin-to-glucagon ratio

Glucose is low (normal range 3.0-5.5mmol/l)

Increase in NEFA - breaking down lipids and fats

Increase then decrease in amino acids

Proteolysis

Lipolysis

HGO

Ketogenesis production

Muscles will use lipids and brain will use glucose adn ketons

Question 16

What hormones and pathways happen in the fed state

Answer 16

High insulin release flowed by slower insulin release

Increase in glycogen

Stop HGO

Decrease gluconeogensis

Increase protein synthesis

Decrease proteolysis

Lipogenesis

Question 17

How do you diagnose diabetes mellitus

Answer 17

Fasting glucose >7.0mmol/L

Randome glucose >11.1mmol/L

Oral glucose tolerance test

HbA1c (>48mmol/mol)

Need 2 positive test or 1 positive test and symptoms

Question 18

What is the pathophysiology in type 1 diabetes

Answer 18

Autoimmune condition

Absolute insulin deficiency

Diabetic ketoacidosis

Question 19

What are the presentations of T1DM

Answer 19

Weight loss - protein break down

Hyperglycaemia

Glycosuria - polyuria, polydipsia, nocturia

Ketones in blood and urine

Question 20

What is the useful diagnostic test of T1DM

Answer 20

Antibodies: GAD, IA2

Low C peptide

Presence of ketones

Question 21

What is insulin induced hypoglycaemia

Answer 21

Where you take too much insulin

Question 22

What is the couterregulatory response to hypoglycaemia

Answer 22

Increae glucagon, catechoalmines, cortisol and growth hormone

Increase HGO and glycogenolysis, glyconeogensis, lipolysis

Question 23

Why is imparied awareness of hypoglycaemia bad

Answer 23

Reduce awareness of hypoglycaemia

Due to threshold of glucose being reset

Recurrent hypoglycaenia

Question 24

Symptoms of hypoglycaemia

Answer 24

Sweating, pallor, palpitations, shaking Slurred speech, Poor vision, confusion, seizures, loss of consciousness

Question 25

What is severe hypoglycaemia

Answer 25

Episode where a person needs third party assistance

Question 26

What is the pathophysiology in type 2 diabetes

Answer 26

Enough insulin to suppress breakdown of protein and ketogenesis

Question 27

What happens during insulin resistance

Answer 27

P13K-Akt pathway because resistance however MAPK apthway still works Increase insulin production results in increase growth and proliferation - growth of arteriols which lead to high blood pressure

Question 28

What are the consequences of insulin resistance

Answer 28

Derangement of lipid Hyeprtension Increase weight Inflammatory states Decrease energy expenditure

Question 29

What is the presentaiton of T2DM

Answer 29

Hyperglycaemia Overweight Less osmotic symptoms Dyslipidaemia Insulin resistance

Question 30

What are the risk factors of T2DM

Answer 30

Age Increase BMI Ethnicity Family Inactivity PCOS

Question 31

What are diabetes complications

Answer 31

Question 32

What treatment are there for diabetes

Answer 32

Healthy eating or diet control - Reduce calories in fat and refined carbohydrates, sodium, increase fibre and complex carbs

Question 33

What is the management of type 1 diabetes

Answer 33

Type 1 - exogenous insulin (basal-bolus regime, long acting once or twice a day and quick acting right before meal) Self-monitoring of glucose Technology Education

Question 34

What is the management of type 2 diabetes

Answer 34

Diet Oral medication Education May need insulin later

Question 35

Long term coseuqences of diabetes

Answer 35

Retinopathy Neuropathy Nephropathy Cardiovascular disease