Diabetes

Question 1

osmotic diuresis

Answer 1

excessive production of urine

when sugar high, leaks into urine so pulls water out of body

Question 2

thrush

Answer 2

white cheesy discharge
candida likes sugar in blood

Question 3

serum sodium level in diabetes

Answer 3

higher blood sugar, lower serum sodium

blood becomes osmolar (more solute)
osmolality sucks water out of cells
=hyperosmolar hypernatraemia (high sodium conc)

shrinks cells
dilutes the sodium
cells shrunk too much -> drowsy and unconcious
-> hyperosmolar hyperglycaemia

Question 4

why might diabetic patients lose weight

Answer 4

deficient in insulin
(insulin signals that the body has glucose)
w/o insulin, body becomes catabolic and starts breaking down tissues to make sugar
breaks proteins to sugar
fat into ketones
muscle cells to amino acids

Question 5

ketones
capillary beta-hydroxybutyrate
acetoacetate

Answer 5

ketones acidic
B hydroxybutyrate is capillary ketone (more accurate measurement)

acetoacetate is urine ketone

causes acidosis in dka

above 3mmol/L is high

Question 6

HCO3 measurement

Answer 6

bicarbonate
low signals metabolic acidosis

Question 7

low PaCO2 result

Answer 7

partial pressure co2

patient hyperventilating
respiratory compensation

Question 8

diabetic ketoacidosis

Answer 8

caused by insulin deficiency
precipitated by infection, steroids, trauma, hyperthyroidism

ketogenesis causes metabolic acidosis
hyperglycaemia causes osmotic diuresis and dehydration

Question 9

biochemistry of dka

Answer 9

insufficient/no insulin
increased glucagon
breaks fat cell to glycerol and fatty acid by lipolysis
fatty acids converted to ketones

glucagon activates release of glycogen stores
stimulates release of sugar from liver

reduced uptake of glucose

muscle - amino acids,
glycerol and other subtrates in liver converted to glucose

blocked krebs cycle

increased ketone and glucose production

Question 10

treating dka

Answer 10

initially
IV drip
add insulin and saline
add na water and k

crystalloids to replace Na and K

then
subcutaneous insulin once K down (K is high at first because acidosis causes k to leak out of cells)

Question 11

pregnancy and ketones

Answer 11

increased ketones
inc risk of ketoacidosis

Question 12

type 1

Answer 12

autoimmune process against pancreatic beta islet cells

inc risk of other autoimmune diseases

absolute insulin deficiency

weight loss
young people

treat w insulin

Question 13

closed loop system for type 1
and current

Answer 13

continuous glucose sensor

insulin pump hosting control algorithm

in development

currently
insulin 4x a time
hybrid closed loop system

Question 14

type 3c

Answer 14

damage to pancreas from exocrine pancreatic damage (alcoholic pancreatitis or pancreatic cancer)

absolute insulin deficiency

associated exocrine pancreatic dysfunction

steatorrhoea (excessive excretion of fat)
cant digest fat

treat w insulin
creon enzyme supplements

Question 15

type 2

Answer 15

insensitivity/ insulin resistance
defect in signalling pathway
or beta cell failure

obesity- fat not stored in fat cells, stored in muscle and liver, muscle less sensitive

less ketone prone
dka for severe cases
for BAME subjects

body produces more insulin to compensate
pancreas overworked
insulin levels drop

Question 16

pathophysiology of type 2

Answer 16

beta cells produce less insulin
insulin deficiency
increased production
alpha cell produces excess glucagon
excess glucose output
hyperglycaemia

insulin resistance
decreased glucose uptake
sugar from meals not stored in muscles and fat
stays in blood stream
hyperglycaemia

Question 17

type 2 diabetes timeline

Answer 17

progressive decline in beta cell function

screening for pre diabetes before 50% can prevent

Question 18

HBA1c

Answer 18

glycated haemoglobin
shows glucose levels for past 3 months
(life span of red blood cell)
(like average glucose level)

higher means more risk of diabetic complications

Question 19

diagnosing type 1

Answer 19

autoantibodies against pancreatic islets
markers for autoimmune disease

eg
antiGAD, anti Zn transporter, anti insulinoma

Question 20

measuring c peptide

Answer 20

measures amount of endogenous insulin production

proinsulin = insulin + c peptide

cpeptide only produced by pancreas

distinguishes between insulin from patient and insulin from injection

Question 21

diagnosing type 2

Answer 21

c peptide high

low for type 1 after 6 months
low for type 3c

Question 22

diagnosing type 3c

Answer 22

CT pancreas
for chronic pancreatitis

faecal elastase levels low if exocrine deficiency

Question 23

diabetes microvascular complications

Answer 23

diabetic retinopathy
periodontal disease
diabetic nephropathy
erectile dysfunction
diabetic neuropathy

Question 24

diabetic macrovascular complications

Answer 24

stroke
depression
heart disease
fatty liver disease
peripheral vascular disease
amputation due to gangrene, infections

inc risk of atheroma and thrombus

Question 25

controlling hyperglycaemia in type 2

Answer 25

insulin sensitisation drugs

glucose excretion

insulin secretion

insulin replacement

Question 26

kussmaul breathing

Answer 26

an abnormal breathing pattern characterized by rapid, deep breathing at a consistent pace. It’s a sign of a medical emergency — usually diabetes-related ketoacidosis (DKA), which can affect people with diabetes and people with undiagnosed Type 1 diabetes