Week 1 (L1-L3)

Question 1

Main factors contributing to cardiovascular disease (CVD)

Answer 1

Smoking
High BP
High cholesterol

Question 2

What genes affect obesity susceptibility:

Answer 2

leptin: secreted by adipose tissue affecting energy expenditure
Leptin resistance —> less negative feedback from adipose tissue to hypothalamus.

Question 3

What can obesity lead to

Answer 3

1. Type 2 diabetes
2. cardiovascular disease
3. High cholesterol level in bile acid —> gallstones –> NAFLD

Question 4

What is diabetes mellitus

Answer 4

chronic hyperglycaemia – disturbed carbohydrate and lipid metabolism.
due to insulin resistance and lack of insulin production

Question 5

Fasting glucose readings

Answer 5

The test to see how the body handles glucose metabolism in a fasting state.
If the fasting glucose readings is relatively high, it indicates impaired fasting glucose
- prediabetic, because liver produces exceeding levels due to IR.

Question 6

2h plasma glucose readings

Answer 6

The test is doneto check how the body deals with influx of sugar
If the 2h plasma glucose readings is high, then it means impaired glucose tolerance
IMPAIRED ABILITY TO DISPOSE GLUCOSE

Question 7

Diabetes (fasting glucose/glucose tolerance readings)

Answer 7

Fasting glucose: ≥7.0 mmol/l
2h plasma glucose: ≥11.1 mmol/l

Question 8

Why isn’t urine glucose tested anymore?

Answer 8

Some people have higher renal reabsorption threshold, some lower.

Question 9

what are osmotic symptoms in the context of diabetes

Answer 9

Classic symptoms of diabetes: polyuria or polydypsia

DM: when the body is trying to rid of the glucose.
DI: insensitivity to ADH or lack of its production.

Question 10

Why are 2 confirmatory readings required when there are no osmotic symptoms of diabetes

Answer 10

Fluctuation of glucose levels: these criteria usually require confirmation by repeat testing on a different day if there are no classic symptoms

Question 11

Type 1 diabetes consequences

Answer 11

No insulin secretion:
1. muscle cells have no glucose uptake
2. ketosis happens, FFA will undergo lipolysis to turn to another fuel, ketone

Question 12

Type 2 diabetes mellitus consequences

Answer 12

Insulin resistance:
Muscle cells cannot utilise blood glucose well.

Question 13

ketosis in T1 and T2 diabetes mellitus

Answer 13

There is ketosis in T1 but no ketosis in T2.

Question 14

What happens in ketosis

Answer 14

Body’s fasting state:
adipose tissue will breakdown triglycerides and release FFA.
FFA undergoes beta-oxidation turning to acetyl-CoA.
Acetyl-CoA accumulation lead to conversion to ketone.

Question 15

What is diabetic ketoacidosis

Answer 15

In Type 1 Diabetes Mellitus, insulin insufficiency will lead to the accumulation of ketones.
Acidic ketone bodies accumulation in the circulation will decrease the pH of the blood.

Question 16

Diuresis in diabetes mellitus

Answer 16

high blood glucose which exceeds max renal reabsorption, glucose can act as an osmolyte.

Question 17

Macrovascular complications of hyperglycaemia

Answer 17

• Atheroma (plaque/fatty tissue build up in artery)
• cardiovascular disease
• peripheral vascular disease (foot ulcer)

Question 18

Risk of micro/macrovascular damage by blood sugar

Answer 18

Macrovascular is linear, microvascular is a curve

Question 19

Examples of incretins

Answer 19

1. Glucagon like peptide 1 (GLP 1)
2. GIP

Question 20

abnormal incretin in T2 diabetes

Answer 20

1. Impaired incretin effects
2. some incretins are low (GLP-1) in T2 diabetes
3. DPP inhibitor is used in T2 diabetes, because the enzyme, DPP 4, will inactivate incretins

Question 21

Microvascular complications of hyperglycaemia

Answer 21

• retinopathy
• nephropathy

Question 22

What do incretins do

Answer 22

produced in the GI after food intake,
1. increase insulin secretion
2. suppresses appetite

Question 23

how does T2 diabetes affect incretin

Answer 23

T2DM will suppress incretin effect

Question 24

hyperglycaemia causing neuropathy

Answer 24

1. The accumulation of AGEs in nerve vessels, for example, inducing inflammation.
2. Atherosclerosis can damage both blood vessels and lead to poor perfusion to nearby nerves, especially in peripheries)

Question 25

What are AGEs (advanced glycation end products) in diabetes

Answer 25

due to chronic hyperglycaemia, glucose will bind to proteins, lipids, etc.

Question 26

T1 vs T2 diabetes (main apparent differences)

Answer 26

T1 is often associated with weight loss and being thin.
T2 is caused by obesity, and often feeds back to weight gain.

Question 27

Type 1 diabetes treatment and complication

Answer 27

1. Insulin injections
2. beware of hypoglycaemia

Question 28

Type 2 diabetes treatment options

Answer 28

1. Diet changes and exercise
2. Drugs to sensitise insulin