Case 5 - Diabetes

Question 1

Identify 1, 2, and 3 from the animation / diagram:

What are the steps A, B and C?

*put in pic*

Answer 1

1 - insulin

2 - insulin receptor

3 - Glut-4 transporter channel

A - Glycolysis

B - Link Reaction

C - Kreb’s / TCA cycle

Question 2

GLUT-4 insulin regulator glucose channel, found predominantly in fat and muscle:

Where else is the GLUT-4 receptor found?

Answer 2

Adipose tissue

Striated muscle

Heart muscle

Endothelium

Kidney

Neurons

B-cells in the pancreas

Question 3

Where is glucose actively transported?

Answer 3

Ileum / gut and kidneys

Question 4

Do GLUT-1, 2, and 3 require insulin to work?

In which tissues are GLUT-1 found?

In which tissues are GLUT-2 found?

In which tissues are GLUT-3 found?

Answer 4

No, they are insulin independent

Question 5

How many ATPs are generated overall per glucose molecule in aerobic respiration?

Answer 5

Around 30 ATP molecules

Question 6

What are the functional effects of insulin on the liver, muscle and fat?

Answer 6

Aim = storage

Uptake of glucose for storage as glycogen (glycogenesis) - the liver and muscle

Prevents gluconeogenesis / glycogenolysis - in liver and muscle, also therefore prevents release of amino acids in muscles as muscle is prevented from being broken down

Promotes lipogenesis in fat tissue / prevents lipolysis

Question 7

What are the causes of Type II diabetes?

What is the tipping point to developing Type II diabetes?

Answer 7

Insufficient insulin production (to counteract the reisstance)

Resistance to insulin in GLUT-4 receptors

Insulin resistance = negative feedback loop with rising blood sugar levels causes the B-cells in the pancreas to release more insulin. But eventually, the B-cells cannot produce enough insulin to meet the requirements, which is the tipping point to developing diabetes

Question 8

What would the blood results of of Type II diabetes show?

Answer 8

Increased blood glucose levels

More lipolysis, less lipogenesis, so more free fatty acids in blood

More amino acids, more protein breakdown than protein storage

Question 9

How can obesity develop?

Answer 9

Combination of environmental factors and family history / susceptibility genes

Diet

Question 10

How can insulin resistance develop? (idek what the q was)

What is the viscious cycle of diabetes?

Answer 10

Adipokines (come from fatty tissues) - toxic actions on some tissues, including B-cells

Visceral fat is more susceptible to insulin resistance

complex pathology - combo of genes / family history, high BGL damages B-cells in pancreas, diabetes leads to lipolysis, breakdown of fat releases adipokines, which are toxic to B-cells …?

Question 11

Put in pics of wooclap - match 1,2,3,4 with A,B,C,D?

Answer 11

1 - D (impaired glucose tolerance)

2 - B (Impaired fasting glucose)

3 - C (Normoglycaemia)

4 - A (T2DM)

Question 12

In which sequence did the conditions occur?

What are the normal ranges? *put in pics*

Answer 12

1. Normoglycaemia
2. Impaired fasting glucose
3. Impaired glucose tolerance
4. T2MD

UK use 5.5 to 6.9 for fasting glucose levels, so normal = below 5.5 and more than 7 = diabetic range

Question 13

How to test post-prandial glucose (after eating)?

What is the normal range?

Answer 13

75g sugar given

tests if the body can respong to a big meal - less than 7.8 mmol/l in normal, 7.8-11.1 = IGT, T2MD = above 11.2

Question 14

Using the table, how can diabetes be diagnosed?

Answer 14

IGT - After a meal = abnormal, but in fasting state = less than 7 (so can be normal levels) = isolated IGT

If after a meal = abnormal, and fasting glucose is also abnormal = IGT and T2MD

IGT or IFG can happen in either order

Ask is they have symptoms - e.g. thirst, lots of peeing, unintended weight loss

Only use the values when present with symptoms

Question 15

What is pre-diabetes?

What is meant by the terms IFG, IGT, IGR (imparied glucose regulation), non-diabetic hyperglycaemia, and borderline diabetes?

Answer 15

IGR = umbrella term, under which IFG and IGT are found (so IFG and IGT are different things)

What makes IFG and IGT different, pathophysiologically?

IGT = cannot manage glucose after a meal, (after a meal, most glucose goes into muscles), so muscle intolerance to insulin = huge contributor

IFG = resistance in the liver

Question 16

For a patient, what would pre-diabetes make them do?

Answer 16

Lifestyle changes - to diet and exercise

Question 17

Which is the least useful in diagnosing T2DM?

What is the renal threshold for glucose?

So if someone has glucose in their urine, are they definitely a diabetic?

Answer 17

Random glucose levels

10 mmol/l

No, normal range randomly = less than 11 mmol/l; also other conditions can result in glucose in the urine

Question 18

What is HbA1C?

What are the advantages and disadvantages for HbA1C as a diagnostic tool for diabetes?

Answer 18

Hb that has been glycosylated - can be used to diagnose diabetes?

Adv - RBCs last 120 days so shows glucose control over a 3/4 month period; no fasting or sugary drinks, can take it at any time

Disadv - anaemia; SCA; pregnancy (expands blood volume); HIV; advanced kidney disease; repeating the test (to see if results are sustained); requires a normal range for it to be compared against; if RBCs are dying early, gives a false result

Question 19

What are risk factors for the development of T2MD?

Answer 19

Gender, ethnicity (Indian, South Asian, Afro-carribeans, Hispanics), obesity, susceptible genes (family history), diet, hypertension

Cannot change: ethnicity, gender, susceptible genes, age, family histroy

Can change: weight, diet, exercise

High glucose symptom of diabetes can lead to depression - correlation, not causation

Question 20

How has Type I and Type II diabetes cases changes over time?

Answer 20

Type II = raising, due to rising levels of obesity

Type I - same

Question 21

What is the NHS Diabetes Prevention Programme?

Answer 21

Behavioural interventions - lifestyle changes to help reduce Type II diabetes rates

Question 22

What does the weightloss intervention show?

Answer 22

Once the intervention has ended, they put on 25% of the weight they lost - difficult to retain / maintain weight loss

Question 23

What is behavioural insights?

Answer 23

Approach we can take to understand why epople have certain behaviours, then put interventions in place to change those behaviours (tackle root cause)

Question 24

How can the NHS improve uptake, retention and behaviour change for behavioural insights in the DPP?

Answer 24

Uptake - GP explains in consultation, infographics, target audience (make the people feel relateable to the people it matters to), make the infographics pcitorial / in different languages

Retention - Set achieveable end goal; easy to enroll so they aren’t put off; easy to access, local; sessions not interfere with daily life; friendly competition / dynamic = fun

Behaviour changes - progress monitoring; social acitvities with groups of people with similar goals = motivation + accountability; healthy recipes; meal prep; prevent impulsive buys

Question 25

What is medication for Type II diabetes?

Answer 25

Metformin - first choice of drug, because: works by increasing cell sensitivity to insulin and lowering amount of glucose released by the liver, easy to take (tablet instead of injections), does not cause weight gain (unlike other medications); reduces CVD risk; cheap drug; wider mechanism of action (less understood but it works)

Few side effects of metmorfin - funny tummy, loose tool, diarrhoea (tolerable / adjust doses)

Insulin - given late into progression of T2MD

Question 26

What is a part of the patient’s profile?

Answer 26

Works are a urologist at the hospital