Diabetes

Question 1

What does the pancreas produce?

Answer 1

Glucagon, insulin, somatostatin, pancreatic polypeptide.

Question 2

What does glucagon do?

Answer 2

Stimulates the release of stored glucose from the liver to raise blood sugar levels.

Question 3

What does insulin do?

Answer 3

Aids glucose transport into cells and promotes glucose storage.

Question 4

What is diabetes mellitus?

Answer 4

Insulin deficiency or resistance.

Question 5

What is type one diabetes mellitus?

Answer 5

Genetic predisposition juvenile onset usually around time of puberty but can be anytime, permanent insulin deficiency due to unknown cause - idiopathic. The beta cells in the pancreas are destroyed or suppressed by autoimmune attack or trauma to pancreas. Insulin dependant diabetes. Classic triad polyuria, thirst and weight loss.

Question 6

What is type two diabetes mellitus?

Answer 6

Non-insulin dependent. Caused by: Resistance to insulin actin in target tissues. Abnormal insulin secretion. Inappropriate gluconeogenisis. Often result of obesity. Typically develops in middle life caused by interaction of life style factors and genetic factors. 80 % of type 2 are obese. Lack of exercise, increasing age. Consumption of sugary foods overuse of insulin receptors.

Question 7

How can diabetes mellitus present itself?

Answer 7

Excessive thirst Excessive urination Weight abnormalities Excessive sugar in urine

Question 8

What is epidemiology of diabetes mellitus?

Answer 8

4.3% of population (2.8 million people) African or Caribbean more at risk Incidence increases with age Fifth leading cause of death in UK. Scott 2012

Question 9

Describe normal control of blood sugar.

Answer 9

High blood sugar > beta cells in pancreatic islets of langerhans release insulin which travels via the hepatic portal vein to the liver then all tissues of the body via systemic circulation opening portals in cells so glucose can be transferred into cell for use by mitochondria for energy production. Plus induces the conversion of soluble glucose into insoluble glycogen for storage in liver and muscles. Low blood sugar > alpha cells of pancreas release glucagon which causes liver to release glucose into blood stream.

Question 10

If high blood sugar is left untreated what will happen?

Answer 10

Heart disease Peripheral vascular disorders Vision problems Kidney disease Skin disease Autonomic neuropathy

Question 11

What is the treatment for diabetes mellitus?

Answer 11

Type one insulin to replace natural insulin. Type two controlled by diet and oral meds that aim to stabilise and reduce amount of glucose consumed. Can lead to insulin dependency.

Question 12

Symptoms of hypoglycaemia BM < 3 mmol/L

Answer 12

Adrenaline released to counter hypoglycaemia - stimulates sympathetic nervous system - sweating/pallor/tremor/tachycardia. (The adrenergic features) Second group of features due to reduced metabolic activity in brain. Confusion/ behavioural changes/ slurred speech/ drowsiness. Can cause cardiac dysrhythmias and respiratory arrest NB life threatening! Rapid onset Hunger Anxiety Sweating Cool, clammy skin Confusion leading to coma Behavioural changes Increased HR

Question 13

Symptoms of hyperglycaemia BM > 13.8 mmol/L

Answer 13

Gradual onset Polyuria Poldipsia Nausea Vomiting Fatigue Stupor leading to coma Abdominal pain Increase in RR and depth with fruity smell (Kussmaul respiration) Increased HR and hypotension

Question 14

Treatment for hyperglycaemia

Answer 14

Transport to hospital Paramedic may give fluids to treat hypotension Patient requires hospital administered insulin done by medical specialists

Question 15

Treatment for hypoglycaemia

Answer 15

If conscious and cooperative Oral glucose - dextrose 40 % gel - rapid absorption through buccal mucosa resulting in rapid increase I’m blood glucose level. Followed by slow release carbohydrates If unconscious or uncooperative Glucagon - IM 1 mg induces conversion of glycogen to glucose in the liver thereby raising blood sugar level. Followed by slow release carbohydrates Paramedic drug of choice glucose 10% IV reverses hypoglycaemia.

Question 16

Normal blood sugar range is?

Answer 16

3.5 to 8 mmol/L

Question 17

What happens if there is not enough glucose in the diet?

Answer 17

Liver can produce glucose through process called gluconeogenesis. Chemical rearrangement of fat and protein derived molecules. Adult brain consumes 100 g of glucose a day and can only use glucose I.e. Obligatory glucose user. Hence why hypoglycaemia is life threatening. If very low, no energy brains cells die rapidly. In order to protect brain neurones are able to absorb glucose directly without gating effect of insulin. Campbell, 2011

Question 18

What is ketoacidosis?

Answer 18

If glucose not available as fuel, fat will be used. Fat metabolism by mitochondria produces ketones. This leads to ketoacidosis. Results in hyperventilation to reduce acidosis. Blowing off co2 reducing carbonic acid lowers acidity. Gives rise to Kussmaul respirations. Smells of pear drops Campbell, 2011

Question 19

Why might diabetes mellitus cause chf?

Answer 19

Glycosylation of heart muscle proteins Describes the addition if sugar molecules to proteins and lipids.

Question 20

How many people are estimated to have diabetes mellitus in Uk and not know?

Answer 20

850,000 (Diabetes UK 2011)

Question 21

What causes hypoglycaemia?

Answer 21

Most common cause - over administration of insulin. Or take insulin but fail to eat. Systemic infections due to high metabolic requirements for glucose. Mostly occur at night or before meals.