Clinical Diabetes

Question 1

how can diabetes be diagnosed?

Answer 1

fasting blood sugar with venous blood sugar sample

Question 2

why cant a fingerprick test diagnose diabetes?

Answer 2

this is capillary blood sugar

Question 3

what are normal blood glucose levels compared to diabetic ones?

Answer 3

5 mmol/L is normal

7+ is diabetic

Question 4

what is an oral glucose tolerance test?

Answer 4

give 75mg of glucose and test blood sugar again 2 hours later. 11.1 mmol/L + is diabetic

Question 5

what is polyuria?

Answer 5

frequent urination

Question 6

what is polydipsia?

Answer 6

frequent thirst/dehydration

Question 7

what is glycosuria?

Answer 7

excess sugar in urine

Question 8

what is type I diabetes?

Answer 8

beta cell destruction

Question 9

what is type II diabetes?

Answer 9

insulin resistance or deficiency due to beta cell disfunction

Question 10

most common cause of type I diabetes mellitus?

Answer 10

autoimmune destruction of beta cells leading to no beta cell function

Question 11

what are environmental factors contributing to type I?

Answer 11

viruses that can destroy beta cells (mumps, rubella), diet, stress, drugs

Question 12

what is type II diabetes mellitus linked to?

Answer 12

insulin resistance and high BMI

Question 13

what is the difference between white patients and indian patients in onset of type II diabetes?

Answer 13

younger age of onset with earlier proteinuria and renal disease.

Question 14

what percentage of diabetes incidence is type II?

Answer 14

85%

Question 15

where does insulin act?

Answer 15

adipose tissue, muscle and liver

Question 16

what does lack of insulin lead to?

Answer 16

raised blood glucose levels. adipose tissue breaks down leading to diabetic ketoacidosis

Question 17

what can intensive insulin treatment lead to?

Answer 17

hypoglycaemia

Question 18

what would be an ideal diabetes treatment?

Answer 18

pancreatic transplant or beta cell transplant

Question 19

what is type II diabetes mellitus a combination of?

Answer 19

insulin resistance and beta cell dysfunction

Question 20

how does beta cell dysfunction come about?

Answer 20

genetic/environmental factors lead to insulin resistance so the beta cells release very large amounts causing hyperinsulinaemia . eventually beta cells stop working and cannot cope so they begin to dysfunction. the beta cells work so hard, they cant cope and dysfunction –> hyperglycemia

Question 21

which type has more severe insulin deficiency?

Answer 21

type I

Question 22

what are aims of treatment in type II diabetes mellitus?

Answer 22

• abolish symptoms/complications of hyperglycemia
• reduce threat of complications
• increase life expectancy
• restore life quality

Question 23

what are early treatments of diabetes?

Answer 23

encourage patients to lose weight and exercise

Question 24

what are insulin sensitisers?

Answer 24

decrease insulin resistance at target tissues so pancreas produces more insulin

Question 25

what do effects of insulin sensitisers achieve?

Answer 25

- decrease plasma glucose levels - decrease excessive lipolysis and reduce FFAs - decrease hepatic gluconeogensis - improve insulin mediated glucose uptake

Question 26

what are the steps of treatment?

Answer 26

diet and exercise --> oral monotherapy --> oral combination --> insulin +- oral agents

Question 27

what is metformin?

Answer 27

decreases hepatic glucose output and decreases fatty acid oxidation

Question 28

how does metformin work?

Answer 28

increases kinase activity of insulin receptor and increases expression of GLUT-4 transporter and increases glycogen storage

Question 29

what are glitazones (thiazolidnediones)?

Answer 29

oral insulin sensitising agents that lower blood glucose and insulin levels

Question 30

what is glitazone mechanism of action?

Answer 30

PPAR- gamma

Question 31

what do both metformin and glitazones do?

Answer 31

increase sensitivity of body to insulin

Question 32

what do sulphonylureas do?

Answer 32

help beta cells produce insulin. they block K+ ATP channels --> depolarisation --> increase insulin release

Question 33

what happens if you stop type I DM insulin treatment?

Answer 33

diabetic ketoacidosis

Question 34

what happens if you stop type II DM treatment?

Answer 34

HONK hyperosmolar non-ketotic coma

Question 35

what are complications of undiagnosed type 2?

Answer 35

cerebrovascular disease, retinopathy, cardiovascular disease, nephropathy, neuropathy, peripheral vascular disease

Question 36

what are microvascular complications (directly related to blood sugar)?

Answer 36

nephropathy, retinopathy, neuropathy

Question 37

what are macrovascular complications (where other things like cholesterol are important)?

Answer 37

CHD/Stroke, Peripheral vascular disease, blood pressure