Diabetes

Question 1

Types of Diabetes?

Answer 1

Type 1
Type 2
Gestational
Drug Induced

Question 2

Pathophysiology of type 1 diabetes?

Answer 2

T cell autoimmunity (type 4 hypersensitivity).

Attacks B cells –> lack of insulin production –> lack of glucose transport into cells –> high blood glucose levels.

Question 3

Symptoms of type 1 diabetes?

Answer 3

• Hyperglycaemia
• Hypoinsulinaemia
• Glycosuria
• Polyuria
• Polydypsia
• Mental status changes (confusion)
• Excessive hunger and weight loss

o Even there is a lot of glucose in the blood, it cannot get into the cells  causes increase in fat breakdown (lipolysis) in adipose tissue and protein breakdown in muscle cells. Both factors (lipolysis and proteolysis) leads to weight loss in a patient with uncontrollable diabetes. This catabolic state leaves people feeling hungry (polyphagia). With high glucose levels in the bloodstream, some of it spills into the urine (glycosuria). Since glucose is osmotically active, water tends to follow glucose into the urine, leading to large volumes of urine become excreted (polyuria). Since there is a large amount of urination, patients with diabetes become very dehydrated and thirsty, known as polydypsia.

Question 4

Serious complication of type 1 diabetes?

Answer 4

Diabetic Ketoacidosis

Question 5

Pathophysiology of type 2 diabetes?

Answer 5

• Body’s cells do not respond to insulin.
• Pancreatic changes (B cell hyperplasia and hypertrophy) to increase insulin production to maintain normoglycaemia. This compensatory mechanism does not last and leads to B cell hypoplasia and hypotrophy ; which in turn leads to hypoinsulinaemia and hyperglycaemia.
• Amylin is also released during the compensatory period. These proteins aggregate and form amyloid deposits within the pancreas.

Question 6

Complication of type 2 diabetes?

Answer 6

HHS

• Hyperosomolar hyperglycaemia state
• Hyperglycaemic state –> hyperosmolairty of the blood –> water diffusion out of cells –> cells shrivel –> excess water removed via urination –> total body dehydration –> mental status changes induced.

Question 7

Tests used to diagnose diabetes?

Answer 7

Fasting blood glucose –> fast for 8 hours.
> Prediabetic: 100-125 mg/dL
> Diabetic: 126+ mg/dL

Non-fasting/random blood glucose
> Diabetic: 200+ mg/dL

Oral glucose tolerance test –> glucose given and glucose removal monitored. Significant reading at 2hrs.

• Prediabetic: 140-199 mg/dL
• Diabetic: 200+mg/dL

Glycated Hb - glucose level within the last 2/3 months

• Prediabetic: 5.7 - 6.4%
• Diabetic: 6.5+%

C-peptide –> indication of how much insulin is being produced. Remember c peptide is a byproduct of insulin production.

Question 8

Treatment of diabetes?

Answer 8

Type 1 
- Insulin 
Type 2 
- Weight loss 
- Exercise 
- Healthy diet 
- Anti-diabetic drugs e.g. metformin 
- Insulin can be used if oral antidiabetic drugs fail

Question 9

Risk of insulin injection?

Answer 9

• Hypoglycaemia (especially If injected without eating food)
• Mild hypoglycaemia –> weakness, hunger, shaking –> treated by using glucose tablets, sugary drinks etc.
• Severe hypoglycaemia –> seizures, coma, confused, agitation –> IV glucose ; intranasal glucagon.

Question 10

Complications of diabetes?

Answer 10

Microvascular changes

• Hyaline atherosclerosis ; endothelial lining damaged by hyperglycaemia –> hyaline deposits form on the inner lining.
• Basement membrane thickens around capillaries –> increase diffusion pathway for oxygen –> hypoxia of tissues
• Endothelial damage –> atherosclerosis –> stroke/MI/infarction of other organs.

Complications
- Retinopathy –> cotton wool changes; flare haemorrhage –> can lead to blindness.
- Effects of autonomic nerves –> gassy, sweating etc.
> Effects of peripheral nerves –> sensory neuropathy –> glove and stock distribution.
- Poor blood supply and damage to nerves can cause ulceration especially at the feet –> may require amputation if not immediately treated.
- Kidneys –> afferent and efferent arterioles and glomerulus become damaged –> nephrotic syndrome –> haemodylasis may be required if damage is extensive.