Diabetes

Question 0

What is hyperosmolar non Ketotic hyperglycaemia?

Answer 0

More often seen in type 2 patients.
There is a similar presentation to DKA, minus ketosis (breaking down fatty acids) and acidosis.
Leads to significant dehydration and 50% mortality

Question 1

Summarise Diabetic Ketoacidosis

Answer 1

Type 1 patients, usually will be treated in hospital. Happens after a lack of insulin (eg missed medication) so there is a rise in glucose leading to hyperglycaemia. Body tries to rid excess glucose through urine which causes excess water to be lost to urine due to osmosis, leading to dehydration. This means blood volume is reduced hence blood pressure drops. Because tissues can’t use glucose as an energy source without insulin the body begins to break down fatty acids for energy. The breakdown products are acidic causing the pH of the blood to drop.

Question 2

Describe the chronic complications and how they differ between types of diabetic patient.

Answer 2

Type 1 - usually no complications at diagnosis but present 5-10 years later
Type 2 - may already have complications at the time of diagnosis and it takes less time for them to develop

Micro vascular complications (retinopathy, nephropathy, neuropathy) are helped by controlling the blood glucose levels

Macro vascular complications (stroke, peripheral vascular disease, MI) are helped by controlling blood pressure and cholesterol

Question 3

How is type 1 diabetes treated?

Answer 3

Insulin
Islet cell transplant
Pancreas transplant

Question 4

How is type 2 diabetes treated?

Answer 4

Diet and exercise
Metformin - improves insulin resistance
Sulphonylureas - make pancreas secrete more insulin