Session 7- An intro to Diabetes

Question 1

What is diabetes

Answer 1

When blood glucose is too high and over years leads to damage of the small and large blood vessels causing premature death from cardiovascular diseases

Question 2

Pathophysiogy of diabetes

Answer 2

As blood glucose rises as you eat the body sends a signal to the pancreas, which releases insulin

Acting as a key insulin binds to a place on the cell membrane undocking the cell so glucose can pass through

Question 3

Why does blood glucose rise

Answer 3

Inability to produce insulin due to beta cell failure

Insulin production adequate but insulin resistance prevents insulin working effectively and invariably linked to obesity

Question 4

Type 1 diabetes

Answer 4

The pancreas does not produce enough insulin due to autoantibodies against the beta cells and insulin producing cells

Question 5

Type 2 diabetes

Answer 5

Your pancreas may not produce enough insulin or your cells do not use insulin properly

Question 6

Typical symptoms of hyperglycaemia

Answer 6

Polyuria 
Polydipsia 
Blurring of vision 
Urogenital  infections- thrush 
Tiredness
Weakness
Lethargy 
Weight loss

Question 7

Diagnosis of diabetes

Answer 7

Fasting glucose
Oral glucose tolerance test
HbA1c

You need symptoms and 1 abnormal test or 2 if asymptomatic

Question 8

How does type 1 diabetes present

Answer 8

Rapid onset weight loss, polyuria, polydipsia

Late presentation- vomiting due to ketoacidosis

Question 9

Treatment of type 1 diabetes

Answer 9

Exogenous insulin given by subcutaneous injection several times a day

Question 10

When do ketone levels increase

Answer 10

In the absence of insulin ketone production is activated

Presence of ketones indice immediate insulin therapy is needed

Question 11

What is ketoacidosis

Answer 11

Hyperglycaemia
Ketoneaemia
Acidosis

Absolute or relative deficiency of insulin
Enhanced lipolysis leads to uncontrolled ketosis
Large quantities of ketone bodes formed including 3-beta-hydroxybutarate and acetoacetic acid and acetone

Question 12

Ketonaemia

Answer 12

> 3.0mmol/L in blood

Question 13

Diagnosing ketoacidosis

Answer 13

Ketonaemia
Ketouria
Blood glucose >11.0mmol/L
Bicarbonate < 15,0 mmol/L

Question 14

What causes insulin resistance in type 2 diabetes

Answer 14

Obesity 
Muscle and liver fat deposition 
Elevated circulating free fatty acids 
Physical inactivity 
Genetic influences

Question 15

Symptoms of type 2 diabetes

Answer 15

Polyuria polydipsia weight loss

May be asymptomatic

Question 16

Acute complications of diabetes

Answer 16

metabolic deomposition
diabetic ketoaciodis in type 1
hyperosmolar non-ketotic syndrome in type 2
Coma

Question 17

Chronic complications of diabetes- macro vascular

Answer 17

Cerebrovascular, cardiovascular peripheral vascular disease

-Strokes MI, intermittent Claudication, gangrene

Question 18

Microvascular complications of diabetes

Answer 18

Microvascular or capillary disease
-retinopathy, nephropahy, neuropathy, blindness, renal replacement therapy, erectile dysfunction, foot ulceration, diarrhoea, constipation, painful peripheral neuropathy

Question 19

What is metabolic syndrome

Answer 19

Cluster of the most dangerous risk factors associated with cardiovascular disease: diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and BP

All confer a marked increase in cardiovascular disease

Question 20

What causes metabolic syndrome

Answer 20

Insulin resistance and central obesity, genetics physical inactivity, ageing

Question 21

What is insulinitis

Answer 21

Inflammation of the islets

Question 22

Auto-Antibodies detected in type 1 diabetes mellitus

Answer 22

ICAs- Islet Cell Auto-antibodies
IAAs- Insulin Auto-Antibodies
IA2- an islet secretory protein
GAD- Glutamic Acid Decarboxylase

Question 23

Progression of type 1 diabetes

Answer 23

Insulin deficiency

Catabolic state

Hyperglycaemia
Ketoacidosis
Dehydration

Coma
Death

Question 24

How can untreated Type 1 lead to coma

Answer 24

Lack of insulin and corresponding elevation in glucagon

Rapid lipolysis

Excess fatty acids converted to ketone bodies in liver - smell of acetone on breath and ketouria

Ketoacidosis

Hyperventilation, nausea, vomiting, abdominal pain, coma

Question 25

How can you test for diabetes

Answer 25

Urine

Finger prick - glucose and ketones

Smell of acetone on breath

Blood sampl for measurement of glucose urea, electrolytes HbA1c

Check for signs of dehydration

BP, pulse, chest sounds

Check RR

Question 26

How do you treat type 1 DM

Answer 26

Diet and exercise

Insulin therapy

Question 27

Macrovascular complications of diabetes mellitus

Answer 27

Increased risk of stroke

Increased risk of myocardial infarction

Poor circulation to periphery - feet

Question 28

Microvascular complications of DM

Answer 28

Diabetic eye disease

Retinopathy

Nephropathy

Neuropathy

Diabetic foot

Question 29

Retinopathy

Answer 29

Damage to blood vessels in retina leading to blindness

Question 30

Neuropathy

Answer 30

Peripheral nerve damages producing loss of sensation

Question 31

Diabetic foot

Answer 31

Poor blood supply damage to nerves, increased risk of infection. Foot ulcers

Question 32

Nephropathy

Answer 32

Damage to glomeruli can lead to microaluminuria

Question 33

Features of T2 DM

Answer 33

Late onset 
Ketoacidosis 
No acute weight loss- often obese 
Rate of fatality slower than type 1 
Insulin replacement not immediate

Question 34

HbA1c test

Answer 34

Measure of glycated haemoglobin reflects average glycaemia over a period of weeks

Non diabetics- 4% - 5.9%

Diabetics 6.5%

Diabetics at higher risk of hypoglycaemia- 7.5&

Question 35

Management of T2 DM

Answer 35

Diet and exercise

Oral hypoglycaemic treatment

Insulin therapy

Metformin

Suphonylureas

Question 36

How does metformin work

Answer 36

Reduces Hepatic Glucose Output

by Inhibiting gluconeogenesis

Question 37

How do sulphonylureas work

Answer 37

Modulates ATP sensitive K+ channels function by decreasing open probability

Stimulates insulin secretion