1. Introduction to Patients with Diabetes

Question 1

Approximately how much of the UK NHS budget is spent on diabetes a year?

Answer 1

10% of it, £11 billion.

Question 2

What is the leading cause of blindness in working age?

Answer 2

Diabetes.

Question 3

How much does type I diabetes reduce life expectancy by?

Answer 3

5-15 years.

Question 4

How much does type II diabetes reduce life expectancy by?

Answer 4

5-10 years.

Question 4

What is diabetes?

Answer 4

Consistently high blood glucose that leads to damage of the small and large blood vessels, causing premature death from cardiovascular diseases.

Question 5

Describe how the body lowers blood glucose after eating.

Answer 5

Signals sent to the pancreas.
Pancreas releases insulin.
Insulin binds to cell surface receptors so glucose can pass into the cells.
Less glucose is in the blood now.

Question 6

Which cells release insulin?

Answer 6

Islet cells in the pancreas, B-cells.

Question 7

What two main reasons causes blood glucose to rise?

Answer 7

Inability to produce insulin due to beta cell failure.

Or adequate insulin production but insulin resistance means it’s ineffective (linked to obesity).

Question 8

What causes type I diabetes?

Answer 8

Autoimmune beta cell destruction, genetically predisposed to it.

Question 9

What is the clinical presentation of diabetes mellitus?

Answer 9

Symptoms of hyperglycaemia: polyuria, polydipsia, blurring of vision, urogenital infections.
Symptoms of inadequate energy utilisation: tiredness, weakness, lethargy and weight loss (type I).

Question 10

What causes type II diabetes?

Answer 10

The pancreas doesn’t produce enough insulin (deficiency) or there is a resistance to insulin of the cells.

Question 11

How can diabetes be diagnosed?

Answer 11

Symptoms and one abnormal test or asymptomatic and two abnormal tests from the following:
Fasting glucose levels
Oral glucose tolerance test
HbA1c test

Question 12

What percentage of type I diabetics are diagnosed under the age of 30?

Answer 12

90%.

Question 13

What is the clinical presentation of type I diabetes?

Answer 13

Rapid onset of symptoms: weight loss, polyuria and polydipsia. If left, vomiting and ketoacidosis.
Normally young patient, under 30 years old.

Question 14

How can type I diabetes be diagnosed?

Answer 14

Elevated venous plasma glucose levels.

Presence of ketones, measured using a ‘ketostik’.

Question 15

How is type I diabetes treated?

Answer 15

With exogenous insulin, given via subcutaneous injections several times a day by pens or pumps.

Question 16

When was insulin discovered?

Answer 16

1921-1922.

Question 17

What percentage of type II diabetics are overweight?

Answer 17

90%.

Question 18

How can type II diabetes be prevented?

Answer 18

Keep BMI between 20 and 25 kg/m2.

Avoid weight gain over 5kg during adult life.

Question 19

What are the risk factors of insulin resistance in type II diabetes?

Answer 19

Obesity (85% of risk of developing type II diabetes), muscle and fat deposition, elevated circulating free fatty acids, physical inactivity and genetic influences.

Question 20

What are the symptoms in type II diabetes?

Answer 20

May be asymptomatic, no urinary ketones.

May have polyuria, polydipsia or weight loss.

Question 21

What happens if type II diabetes is left untreated?

Answer 21

Become more badly hyperglycaemic, inadequate energy utilisation, worsening of complication of the disease (to do with damage to vessels).

Question 22

How is type II diabetes managed?

Answer 22

Lifestyle factors, non insulin therapies (metformin, sulphonylureas etc.) or insulin.

Question 23

What are some acute complications of diabetes?

Answer 23

Hyperglycaemia: ketoacidosis in type I patients, hyperosmolar non-ketotic syndrome (very raised blood glucose but no ketones) in type II patients.
Hypoglycaemia: coma.

Question 24

What are some chronic complications of diabetes?

Answer 24

Macrovascular disease: stroke, heart attack, intermittent claudication (not enough blood to lungs) and gangrene.
Micro vascular disease: retinopathy, nephropathy and neuropathy.

Question 25

What can neuropathy lead to?

Answer 25

Ulcers, a wound is not felt and is unnoticed so can get infected and lead to an ulcer.

Question 26

What can retinopathy lead to?

Answer 26

Blindness.