Week 15: Diabetes Mellitus

Question 1

What is it?

Answer 1

A condition where there is inadequate insulin for carbohydrate metabolism, therefore glucose from the GI tract cannot be metabolised or stored, so reaches higher than normal levels

Question 2

What is insulin and where is it produced?

Answer 2

A hormone that is produced by the islets of langerhans in the pancreas

Question 3

What is insulin used for?

Answer 3

Required for sugar to enter most cells, and regulates blood glucose within a normal range

Question 4

How does insulin work?

Answer 4

Forces many cells of the body to absorb and use glucose thereby decreasing blood sugar levels

Question 5

When is insulin secreted?

Answer 5

In response to high blood glucose

Question 6

When is insulin secretion inhibitied?

Answer 6

By low blood glucose

Question 7

What part of the body does not require insulin to use sugar?

Answer 7

The brain

Question 8

What is the purpose of glucagon?

Answer 8

Assist insulin in regulating blood glucose in the normal range

Question 9

How does glucagon work?

Answer 9

Forces many cells of the body to release glucose to increase blood glucose

Question 10

When is glucagon secreted?

Answer 10

In response to low blood glucose

Question 11

When is glucagon secretion inhibited?

Answer 11

By high blood sugar

Question 12

What is glucose needed for?

Answer 12

Required for fuel as cellular metabolism, the brain also needs glucose

Question 13

Where is the pancreas located?

Answer 13

In the retroperitoneal space

Question 14

What does the pancreas produce?

Answer 14

• digestive enzymes into duodenum
• insulin, glucagon into the blood

Question 15

When is a person considered hypoglycaemic?

Answer 15

non diabetic- <3.3mmol/L
diabetic - <4.0mmol/L

Question 16

What is diabetes insipidus?

Answer 16

A rare form of diabetes where there is inadequate amounts of anti-diuretic hormones (ADH)

Question 17

What are the main symptoms of diabetes insipidus?

Answer 17

• producing large amounts of urine urine, especially at night (polyuria)
• feeling thirsty (polydipsia)

Question 18

What is diabetes mellitus?

Answer 18

A metabolic disease characterised by inadequate or absent insulin production

Question 19

What is type 1 diabetes?

Answer 19

The destruction of islet cells within the pancreas, occurring manly in children and young adults, having a sudden onset

Question 20

What is the cause of type 1 diabetes?

Answer 20

Unknown, but considered it could be hereditary

Question 21

What are symptoms of type 1 diabetes?

Answer 21

• polyphagia
• polydipsia
• blurry vision
• polyuria
• weight loss

Question 22

What is type 2 diabetes?

Answer 22

The most common form of diabetes, blood insulin levels are higher than normal but insulin receptors have become insensitive to it, overall pt produces low levels of insulin

Question 23

What is the cause of diabetes?

Answer 23

Unknown, but common in obese patients, women over 75 and men over 65

Question 24

How is type 2 diabetes controlled?

Answer 24

Via oral or diet controlled

Question 24

What are some symptoms of type 2 diabetes?

Answer 24

- history of high bp - fatigue or low energy - obesity - recurrent infections - polyuria - polydipsia - FBS> 126mg/dl

Question 25

What are some medications that can be used for diabetes?

Answer 25

- givenclamide - cholorpropamide - gliclazide - glimepiride - metformin hydrochloride - tirxepatide

Question 26

How does tirxepatide (monjaro) work?

Answer 26

Activates two receptors to increase hormones on the body, this works to aid insulin and reduces the amount of glucose produced by the liver

Question 27

What do the NICE guidelines state about diabetes medication?

Answer 27

Patients using 3 medications and diabetes management is not controlled or due to side effects of medication

Question 28

What risks are associated with diabetic medications?

Answer 28

Hypos are common with glicazide, glipizide, glimpepiride

Question 29

What is secondary diabetes?

Answer 29

When diabetes occurs due to: - acute or chronic pancreatitis - some drugs - pregnancy

Question 30

What are some complications associated with diabetes?

Answer 30

- cardiovascular disease - infection - renal failure - hypoglycaemic coma - hyperglycaemic coma

Question 31

How does cardiovascular disease create complications?

Answer 31

Atherome and calcification of tunica media can lead to MI/peripheral vascular disease

Question 32

What can thickening of the epithelial basement membrane of arterioles, capillaries and vessels lead too?

Answer 32

- vascular disease - retinopathy - nephropathy - neuropathy

Question 33

What are diabetics more at risk of?

Answer 33

Infection, especially from bacteria or fungi

Question 34

How can diabetes cause renal failure?

Answer 34

Due to vascular changes and infection, its a common cause of death in diabetes

Question 35

What is hypoglycemia?

Answer 35

Occurs when blood glucose levels fall below 4mmol/L

Question 36

What is hyperglycemia?

Answer 36

Diabetic ketoacidosis: - occurs when the body has no insulin to use and switches burning fatty acids and producing ketone acidic bodies

Question 37

What is a symptom of DKA?

Answer 37

Breath has a pear drop smell

Question 38

What is a hypersmolar coma?

Answer 38

Non-kettic coma is a dangerous condition brought on by very high blood glucose levels in T2D (above 22mmol/L)

Question 39

What are causes of hyperglycemia ?

Answer 39

- failure to take insulin - overeating/eating wrong diet - stress (fever, infection, emotional stress)

Question 40

What is the management of someone with hyperglycemia?

Answer 40

- support ABC - treat for hypovolemic shock - check BSM - rapid transport - management - consider interventions: fluids

Question 41

What are symptoms diabetic ketoacidosis?

Answer 41

- blood sugar rises - kindeys try to remove excess water - patients volume is depleted - thirst - tachycardia - hypotension - dry skim, mucous membranes

Question 42

What happens to the body with diabetic ketoacidosis?

Answer 42

- cells cannot burn sugar and patient is hungry - cells burn fat as an alternative fuel - acidic ketone bodies produced - patient tries to correct acidosis - exhales CO2 - rapid, deep breathing

Question 43

What are causes of hypoglycaemia?

Answer 43

- insulin overdose - normal insulin use without eating - over exercise - excess alcohol - patients look shocked, dizzy, lightheaded, confused, sweating

Question 44

What is the management of hypoglycemia?

Answer 44

- give sugar orally/ glucose/ complex carbs - glucose 40% gel - IM glucagon

Question 45

If patient is unconscious and in hypoglycemia what management is needed?

Answer 45

- support ABC's - IM glucagon/IV glucose 10%

Question 46

What questions should you always ask a diabetic?

Answer 46

- have you eaten today? - have you taken your medication today? - are your sugars normally under control? - do you see the diabetic nurse on a regular basis?

Question 47

When can you discharge a diabetic patient at home?

Answer 47

After 30 mins of reassessment to ensure they do not fall low again, a referral must be made to the diabetic nurse or GP as medication may need reviewing