Diabetes

Question 1

diabetes mellitus

Answer 1

metabolic conditions sharing major characteristic of hyperglycaemia

Question 2

what to test in diabetes

Answer 2

random sugar, fasting sugar
glucose tolerance test (GTT)
Hb1AC

Question 3

DM type 1

Answer 3

insulin deficiency
autoimmune destruction of pancreatic B cells

Question 4

DM type 1 aetiology

Answer 4

genetic and environmental

Question 5

what happens in type1DM

Answer 5

immune mediated pancreatic B cell destruction
hyperlgycaemia, ketoacidosis

Question 6

why is having high blood sugar a problem

Answer 6

neuropathy, damage to vascular system, hypertension, risk of MI, angina

Question 7

ketoacidosis

Answer 7

serious, life threatening
not enoiugh sinulin to allow blood sugar in cells for energy, breakdown of fat for fuel producing acid called ketones
too many keytones - dangerous levels

Question 8

child vs adult onset of T1DM

Answer 8

child - ketoacidosis, peak incidence 10-14yr
adult - latent autoimmune diabetes, less weight loss/ketoacidosis, mask as non obese type 2

Question 9

symptoms of T1DM

Answer 9

polyuria, polydipsia, hyperglycaemia, ketoaciddosis

Question 10

T2DM

Answer 10

most common, px over 40, obese

Question 11

aetiology of T2DM

Answer 11

defect in insulin synthesis/secretion/action, B cell response to hyperglycaemia is inadequate
inretin inadequate response, increaed GI absorption
INSULIN RESISTANCE

Question 12

EFFECTS OF T2DM

Answer 12

multisystem impairement - impaired glucose tolerance, hyperinsulinemia, obesity, hypertension, atheroscleorsis

Question 13

medication induced diabetes

Answer 13

corticosteroids - interferes w liver
immune suppressants
cancer medications
antipsychotic medicines
antivirals

Question 14

diabetes related to other conditions

Answer 14

endocrine - cushings, phaechromocytoma, acromegaly
pregnacy, festational diabetes

Question 15

T2DM risk factors

Answer 15

overweight, family history, ethnic groups [asian, afro carribean, middle east], gestational diabetes in previous pregancy

Question 16

summary of differences in DM

Answer 16

1 - young, thin, diabetic symptoms, ketoacidosis
2 - older, obese, strong familyH, present with complications, rarely ketoacidosis

Question 17

core DM management

Answer 17

education - understanding, complication avoidance
targets for blood levels

Question 18

targets for blood sugar levels

Answer 18

pre-prandial - 4-6mmol/L
bedtime - 6-8mmol/L

Question 19

insulin regimes

Answer 19

basal bolus - more injections, better control
split-mixed - fewer injections, poorer control

Question 20

how is insulin administered, what issues with this?

Answer 20

subcutaneous injections
need to rotate site as can lead to fat atrophy if continued use

Question 21

T1DM management

Answer 21

exercise - planned
monitoring - plan dose
nutrition - less than 10% cals from fat, glycaemic index of food
maintain sugar level control

Question 22

T1DM aim for blood sugar

Answer 22

4-7mmol/L

Question 23

insulin monitoring options

Answer 23

continuous glucose monitoring system - tracks glucose, inserted under skin
closed loop monitoring - insulin pump and glucose monitor, insulin released when needed

Question 24

T2DM management

Answer 24

lifestyle - weight loss, diet
medications - metformin
surgery - gastric vertical banding, bariatric

Question 25

medication for T2DM

Answer 25

METFORMIN - first line, enhances cell insulin sensitivity, reduce hepatic gluconeogenesis DDP4 inhibitor - block enzyme metabolising incretin, improve insulin response to glucose incretin = helps insulin last longer GP1 mimetics - same as DDP4, increase incretin sulphonylureas - increase insulin, can cause hypoglycaemia

Question 26

insulin use for T2DM

Answer 26

if px unable to manage glycaemic control with behavuoural changes, weight loss, medication

Question 27

complications of diabetes

Answer 27

hypoglycaemia, cardiovascular risk, increased atherosclerosis, infection risk, neuropathy, atheroma, small vessel disease, diabetic eye disease

Question 28

large vessel atheroma diabetic complications

Answer 28

angina, MI, claudication, anuerysm risls

Question 29

small vessel disease diabetic complication

Answer 29

poor wound healing, easy wound infections, renal disease, eye disease

Question 30

neuropathy complication

Answer 30

numbness of foot, blister, infection, poor healing, necrosis, amputation weakness and wasting of muscles awareness of hypoglycaemia lost, bladder/bowel dysfunction

Question 31

diabetic eye disease

Answer 31

cataracts - opacity in iris, hazy image, lack of sharpness maculopathy - lose cone of retina so lose correct vision proliferative retinopathy - change in blood vessels over retina, haemorrhage in back of eye, treat with lasers

Question 32

dental treatment + diabetes

Answer 32

tx may affect normal routine best time of day for appt, morning, length of appt, manage dosage and food needs

Question 33

dental aspect + diabetes

Answer 33

acute emergencies, complications INFECTION AND POOR WOUND HEALING increased risk of decay, periodontal disease, fungal candidiasis