diabetes

Question 1

Which of the following is a symptom of hyperglycaemia?

a) Increased urine output
b) Weight gain
c) Weight loss
d) Unexplained tiredness

Answer 1

Increased urine output

Question 2

Which of the following is a microvascular complication of diabetes? (1 Mark)

· Hypoglycaemia
· Hyperglycaemia
· Retinopathy
· Hyperkalaemia

Answer 2

retinopathy

Question 3

Identify the two hormones responsible for blood glucose control (2 Marks)

Answer 3

􏰀 Insulin 􏰀 Glucagon

Question 4

The acute complications of diabetes are:
a) Hypertension, hyperglycaemia, and hypoglycaemia
b) Retinopathy, nephropathy and neuropathy
c) Hypoglycaemia, diabetic ketoacidosis and hyperosmolar hyperglycaemic syndrome
d) Erectile dysfunction, peripheral neuropathy and macrovascular disease

Answer 4

a) Hypertension, hyperglycaemia, and hypoglycaemia

Question 5

Insulin is produced by:
a) Beta cells in the pancreas when the blood glucose level falls
b) Alpha cells in the pancreas when the blood glucose level falls
c) Beta cells in the pancreas when the blood glucose level rises
d) Alpha cells in the pancreas when the blood glucose level rises

Answer 5

c) Beta cells in the pancreas when the blood glucose level rises

Question 6

Patients with Diabetic Ketoacidosis often have a significantly increased urine output leading to them becoming rapidly and severely dehydrated. Why does this occur?
a) Breakdown of fat produces ketones
b) The nephron becomes saturated with high levels of glucose
c) The blood becomes acidic
d) Water is lost through rapid breathing rate

Answer 6

b) The nephron becomes saturated with high levels of glucose

Question 7

Which disease process are macrovascular complications of diabetes likely to contribute to?
(1 Mark)
a) Peripheral Vascular Disease
b) Nephropathy
c) Neuropathy
d) Retinopathy

Answer 7

Peripheral Vascular Disease

Question 8

Describe the key differences between Type 1 and Type 2 Diabetes
(8 Marks)

Answer 8

Type1 ————————————————— Type 2
Normally occurs in childhood—————— Normally occurs in adulthood
Autoimmune response————————— Due to lifestyle factors (such as being very overweight)
No insulin is produced—————————- Insulin resistant
Managed with insulin—————————— Managed with healthier lifestyle factors ad medication (inc. insulin)

Question 9

Considering the two hormones responsible for blood glucose control. Explain their actions in response to hyperglycaemia and hypoglycaemia. (6 Marks)

Answer 9

Hyperglycaemia

Receptors detect high blood glucose levels
Beta cells in the pancreas produce insulin
Pancreas releases the hormone insulin
Insulin converts glucose to glycogen to be stored (energy store)
Blood glucose levels return to normal

Hypoglycaemia
Receptors detect low blood glucose levels
Alpha cells in the pancreas produce glucagon
Pancreas releases the hormone glucagon
Glucagon converts glycogen to glucose
Blood glucose levels rise

Question 10

What are the microvascular and macrovascular complications of diabetes?

Answer 10

High blood glucose causes damage to almost every organ system
Kidneys
Eyes
Nerves
Cardiovascular disease
Strokes
Ophthalmology is required because diabetes can causes retinopathy due to high levels of glucose causing damage to eye cells
Podiatry is required because diabetes causes peripheral vascular disease due to high levels of glucose damaging blood vessels and making them narrower

Question 11

What is HHS

Answer 11

HHS (hyperosmolar hyperglycaemic state)
Type 2 diabetes
Gradual onset
Very high blood sugar over a long period of time
No ketoacidosis
Severe dehydration (including in the brain)  confusion, coma

Question 12

What is DKA

Answer 12

DKA (diabetic ketoacidosis)

Type 1 diabetes

Abrupt onset

No insulin = glucose is not stored = no energy store. Stress trigger (infection) causes fat to be burnt instead of glucose. Fat burnt produces ketones (sweat breath). An overwhelming number of ketones makes the blood acidic. Body tries to breathe out more acidic co2 so deep laboured breathing.

Lots of glucose in the blood means kidneys can’t reabsorb all glucose so large volumes of urine, dehydration, excess thirst and sweet breath

Question 13

Describe the Clinical manifestation of hypoglycaemia

Answer 13

Pale
Shaky
Headache
Confused
Fatigue
Hunger
Sweating
Fast heartrate
Blurred vision

Question 14

Describe testing for diabetes

Answer 14

Fasting glucose- Blood glucose after fasting (overnight)

random glucose (finger prick)- How much glucose is circulating in your blood

HbA1C- Average blood glucose levels over 2-3 months

OGTT (ORAL Glucose tolerance test). It takes 2 hours - 2-hour plasma glucose
- Fasting glucose then sugary drink then check blood glucose 2 hours later

Question 15

What are the features of type 2 diabetes?

Answer 15

Insulin resistance
Lifestyle factors
Managed with medication/ tablets / lifestyle factors
Adulthood is when it is usually diagnosed due to poor lifestyle factors
S&S: gradual onset (excessive peeing, thirst and hunger)

Question 16

What are the features of type 1 diabetes?

Answer 16

No insulin is produced by the pancreas
Autoimmune response
Unable to reverse
managed with insulin
Early onset/ childhood
S&S: abrupt onset (excessive peeing, thirst and hunger)