BCH 313 Diabetes Mellitus

Question 1

What is diabetes mellitus

Answer 1

It is not a disease but a heterogeneous group of multifactorial syndrome it is characterized by the elevation of fasting blood glucose caused by absolute or relative deficiency of insulin

Question 2

Diabetes mellitus is the leading cause of what?

Answer 2

Blindness and amputation in adults and the major cause of renal failure heart attack and nerve damage

Question 3

What is the aeitology of type one diabetes

Answer 3

Destruction of beta cells of the pancreas initiated by viral attack or environmental toxins on the pancreas this results in an auto immune attack on the beta cells hence auto immune antibodies T cell insights can be demonstrated in the serum of such individuals

Question 4

What is the chance of the other monozygotic a twin developing the disease?

Answer 4

30-50%

Question 5

Characteristics of patients with type one diabetes

Answer 5

Virtually no functional beta cells
can neither respond to variations in circulating fuels (food nutrients) nor maintain a based secretion of insulin

Question 6

Diagnosis of diabetes mellitus

Answer 6

Adolescent young individual or child

Sudden and rapid onset of symptoms may be triggered by in some stress

symptoms weakness and weight loss

fasting blood sugar less than or equal to 12 pmg/dl

Surgical test demonstrates islet cells antibodies

Question 7

Principal symptoms of diabetes mellitus type one

Answer 7

Polyuria polydipsia polyphagia

Question 8

What happens when blood glucose levels exceed renal threshold

Answer 8

Glucose is excreted in urine (glucosuria)
Due to osmotic affects more water is excreted with glucose (polyuria)

To compensate for the loss of glucose and proteins the patient will want more food (polyphagia)

Question 9

Discuss hyperglycemia as a metabolic change in diabetes mellitus type 1

Answer 9

Increased blood glucose results from gluconeogenesis in the liver and decreased glucose uptake by the insulin sensitive GLUT of full of adipose tissue and muscle for utilization (peripheral glucose utilization)

Question 10

Discuss Ketoacidosis as a metabolic change in diabetes mellitus type 1

Answer 10

Keto acidosis results from increased mobilization of fatty acids from adipose accelerated beat oxidation of FFA on synthesis of ketone bodies in the liver since glucose cannot be to lysed resulting in DKA (diabetic ketoacidosis)

Question 11

What happens to excess FFA that are not used to synthesize ketone bodies

Answer 11

The excess are converted to triglyceride (TG) in very low-density lipoprotein (VLDL) hence high levels in plasma hands hypertriglycerolemia

Question 12

Treatment of diabetes mellitus 1

Answer 12

DM 1 requires exogenous insulin injection to control Hypoglycemia and prevents keto acidosis.

Glycemic control impacts the development of microvascular complications in diabetic patients hence the need for adequate and optimum control of blood glucose

Question 13

Types of treatments in DM 1

Answer 13

Stand Treatment
1 or 2 daily injections achieves glycemic level still above 200 mg/dl and HbAic of 8-9%

Intensive Treatment
3 to 4 daily injections a cheese glycemic level of about 100mg/dl HbAic of 7%

Question 14

Discussed intensive treatment for DM 1

Answer 14

Intensive reaction is aimed at achieve in a tights control of blood glucose but is more prone to the therapeutically hypoglycemia than the standard treatment

Achieves another level of the glucose and glycated hemoglobin values

However intensive reaction is contradicted in children and the elderly

It is meant for me to age people with long-term complications are being avoided

Question 15

Prevalence of type 2 DM

Answer 15

90% prevalence

Question 16

Aetiology of type 2 PM

Answer 16

A combination of dysfunctional beta cell action resulting in lowered insulin levels and peripheral resistance to insulin action

Usually oral hypo are not enough to control the disease but insulin may be in administered in the long run to achieve better control of hypoglycemia and glycated hemoglobin (HbAic) at optimum level (less than 7%)

Question 17

Describe metabolic changes in DM 2

Answer 17

Metabolic changes are milder in DM 2 than DM1 because insulin secretion (though inadequate) is enough to restrain ketogenesis and blunt development of DKA

Question 18

Diagnosis of DM 2

Answer 18

Diagnosis is mainly based on the presence of hyperglycemia greater than 126 MG/100 ML in fasting blood.
No autoimmune antibodies are seen in patients serum

Question 19

 In Monozygotic twins birthday develop DM 2 true or false

Answer 19

True

Question 20

Discuss insulin resistance

Answer 20

The reduced ability of insulin to affect uptake action by target tissues e.g. muscle liver and adipose

It is the decreased ability of target tissues to respond properly to normal/elevated levels of insulin and this result in increased hepatic glucose production and decrease glucose uptake by muscle

Question 21

Explain the relationship between obesity and Insulin resistance

Answer 21

Obesity is the most common cause of insulin resistance

Obese people may not be diabetic because in normal functional beta cells nondiabetic obese individuals have compensatory elevated levels of insulin, to nullify the effects of the peripheral resistances and produce similar blood glucose levels of that of the lean persons

Question 22

Cost of insulin resistance

Answer 22

1. Weight gain increases resistance
2. percentage fat accumulation is important in insulin resistance
3. leptin and adiponectin hormones produced by fat cells also contributes to insulin resistance

Question 23

Metabolic changes in insulin resistance

Answer 23

Hyperglycemia and hypertriglycerolemia also occur in DM 2 but in a milder form

ketosis is minimal or absent

Question 24

Treatments of insulin resistance

Answer 24

Weight reduction
exercise
dietary modification

Oral glycemic agents on insulin may be required to achieve satisfactory glucose levels


Question 25

Complications of diabetes mellitus

Answer 25

Acute:
DKA
hyperglycemia, hypoglycemia hyperosmolaremia (nonketotic)

Chronic affects:
Microvascular complications retinopathy nephropathy neuropathy
Microvascular complications coronary vascular disease myocardial infarction cerebrovascular accident(stroke)

Question 26

What is the most common metabolic emergence in diabetes mellitus

Answer 26

Hypoglycemia is the most common metabolic emerges in diabetes mellitus and is also the most common complication of insulin therapy