DIABETES

Question 1

Explain how ketoacidosis occurs

Answer 1

• Lack of insulin causes fats in the body to break down
• Fats broken down into triglycerides and fatty acids
• Excess fatty acids converted in acetoacetate
• Acetoacetate found in urine and breathed out as a sweet pear drop smell

Question 2

Which drugs can be used to lower Blood pressure

Answer 2

• ACE inhibitors
• Beta blockers
• Diuretics
• Ca2+ channel blockers

Question 3

Give 2 examples of bolus (meal time) insulin medications

Answer 3

• Soluble - Actrapid
• Rapid acting (new) - Aspart (Novorapid)

Question 4

Give two examples of basal (long acting insulin)

Answer 4

• Zinc insulins (old) - insulated
• long acting (new) - levermir

Question 5

Explain a complication of diabetes relating to blood vessels

Answer 5

High blood glucose levels result in high BP. This damages walls of blood vessels causing PLATELET DEPENDANT THROMBOSIS. Platelets stick to the sides of the walls.

Question 6

Give 3 examples of MICROVASCULAR blood vessels that are affected by diabetes

Answer 6

• Eye vessels
• Kidney vessels –> nephropathy
• Nerve damage –> neuropathy

Question 7

Give 4 examples of MACROVASCULAR blood vessels effected by diabetes

Answer 7

• Damage to blood vessels in heart –> CHD
• Reduced or lack of blood flow in legs
• Gangrene - loss of blood supply –> tissue death
• Brain - increased stroke risk

Question 8

How does neuropathy occur?

Answer 8

Blood supply to sensory and motor neurones is lost and this results is loss of function of these nerves. Longest nerves are effected first like nerves in the feet –> peripheral neuropathy

Question 9

Give 4 symptoms of autonomic neuropathy

Answer 9

• Vomiting, diarrhoea, constipation
• Problems having sex
• Increased or decreased sweating
• Changes to how your eyes react to light and dark

Question 10

Explain how insulin is normally produced by cells

Answer 10

• Glucose enters cell via transporter molecules - either GLUT1 or GLUT3
• Inside the cell its converted to Glucose -6- phosphate by glucose kinase
• Glucose -6- phosphate broken down into water and carbon dioxide which generates production of ATP
  ATP acts as a second messenger
• ATP then decreases the activity of the K+ channels in the CSM of the beta cell that result in hyperpolarisation. These are sensitive to ATP
• Less K+ efflux and so reduced hyperpolarisation
• This results in voltage gated Ca2+ channels opening and this triggers exocytosis
• Insulin fuses will cell membrane - exocytosis