Diabetes

Question 1

What is pro-insulin?

Answer 1

It is a long chain of amino acids, made by the beta cells in the ribosomes, and then matured in the Golgi apparatus before being secreted as proper insulin.

Question 2

What is the exocrine function of the pancreas?

Answer 2

To secrete the enzymes needed for digestion into the small intestine- enzymes are amylase, protease and lipase.

Question 3

What are the three different cells in the Islets of Langerhan cells?

Answer 3

Beta, Alpha and Delta cells

Question 4

What do Alpha cells secrete?

Answer 4

Glucagon

Question 5

What do Beta cells secrete?

Answer 5

Insulin

Question 6

What do Delta cells secrete?

Answer 6

Somatostatin

Question 7

What is somatostatin?

Answer 7

They target the pancreatic cells. They regulate hormone secretion of the alpha and beta cells, as well as gastrin and CCK.
‘‘They are the receptors, control centres and then tell the cells next door what to do!’’

Question 8

What are the two things in your body that does not need insulin to utilise glucose?

Answer 8

The brain and RBC

Question 9

What does insulin trigger?

Answer 9

Insulin stimulates Glut4 receptors to move to surface so that more glucose can enter the liver and somatic cells.

Question 10

When BG is high what does it diffuse through into the pancreatic cell?

Answer 10

It diffuses through the Glut2 receptors.

Question 11

What type of hormone is insluin?

Answer 11

An Anabolic hormone

Question 12

What is anabolism?

Answer 12

Anabolism is all of the metabolic processes that build biomolecule

Question 13

What is Diabetes Insipidus?

Answer 13

a rare form of diabetes caused by a deficiency of the pituitary hormone vasopressin, which regulates kidney function.

Question 14

What is the pathophysiology of DM?

Answer 14

Less insulin production or unable to increase insulin production
Less glucose uptake by muscles
Faulty insulin receptors

Hyperglycaemia – lack of glucose in cells
Osmotic effect – blood, urine
Lipolysis – ketosis, acidosis
Catabolism – increased urea, potassium

Question 15

What is osmotic diuresis and how does it occur in diabetes?

Answer 15

The primary cause of osmotic diuresis is elevated blood glucose (hyperglycemia) which is sometimes the result of poorly controlled diabetes. When there is excess glucose in the blood, and it passes through the kidneys for filtering, the excess glucose accumulates in the tubules within the kidneys. Once there, it blocks the reabsorption of water, leading to an increased concentration of water in the bloodstream. The kidneys then act to remove the excess water, causing increased urine production and increased frequency in urination. (polyurea).

Question 16

What is cellular dehydration and how does it occur in diabetes?

Answer 16

Cellular Dehydration occurs when the cell loses more fluid than it takes in.
If our blood glucose levels are higher than they should be for prolonged periods of time, our kidneys will attempt to remove some of the excess glucose from the blood and excrete this as urine.

Whilst the kidneys filter the blood in this way, water will also be removed from the blood and will need replenishing. This is why we tend to have increased thirst when our blood glucose levels run too high.
If we do not have access to drink water, the body will find it difficult to pass glucose out of the blood via urine and can result in further dehydration as the body seeks to find water from our body’s cells (polydipsia).

Question 17

What is cellular starvation occur and how does it occur in diabetes?

Answer 17

In diabetics the lack of insulin (or the resistance to insulin) causes a “starvation” of the cells, which needs the glucose to produce energy. The body’s cells will keep signalling that they need sugar so the hypothalamus sends a signal causing diabetics to feel hungry (polyphagia). Also causes fats to be metabolised.

Question 18

What are the four steps in developing cellular dehydration?

Answer 18

1. Water is lost through sweat
2. Fluid from bloodstream furnishes sweat glands
3. Fluid shifts from tissues (from interstitial fluid) into bloodstream
4. Fluid shifts from cells into tissue

Question 19

What are the steps for for cellular dehydration in diabetes?

Answer 19

1) Hyperglycaemia
2) Increased serum osmolality
3) Increased osmotic pull = water from interstitial space to intravascular space
4) Hypervolaemia
5) Osmosis from cells to interstitial space = cellular dehydration and decreased cellular function

Question 20

What is the glucose transport maximum?

Answer 20

8 mmol/L

Question 21

What does the glucose transport maximum mean?

Answer 21

The maximum amount of glucose that can be reabsorbed in the kidney.

Question 22

What does osmotic diuresis cause?

Answer 22

Hyponatreamia

Question 23

How does osmotic duiresis happen?

Answer 23

1) Hyperglycaemia
2) High glucose in renal filtrate
3) Inability to reabsorb glucose load (renal threshold)
4) Glucosuria
5) Increase renal filtrate osmolality
6) Osmotic pull- water into filtrate= polyuria
7) Loss of electrolytes
8) Dehydration- thirst- polydypsia

Question 24

What does hyperglycaemia cause?

Answer 24

1) Poor perfusion
2) Atherosclerosis
3) Poor wound healing, increased infection
4) Glucose causes cellular damage
5) Metabolic acidosis (hyperventilation)

Question 25

What is fasting glucose test?

Answer 25

Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours.

Question 26

What is postprandial glucose test?

Answer 26

A postprandial glucose test is a blood glucose test that determines the amount of a type of sugar, called glucose, in the blood after a meal

Question 27

What is the difference between hyperglycaemia and hyperosmolar hyperglyceamia state (HHS)?

Answer 27

HHS has some insulin in it; so it does not have to use fat for energy- therefore there will be no ketoacidosis; but everything else is similar.

Question 28

What is hypovolemic shock?

Answer 28

Hypovolemic shock, also known as hemorrhagic shock, is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body’s blood or fluid supply.

Question 29

How do you treat diabetic ketoacidosis?

Answer 29

Isotonic fluids and insulin. Sometimes potassium and bicarbonate.

Question 30

What are the common causes for DKA?

Answer 30

• Failure to take insulin
• Infection
• New diagnosis
• Myocardial infarction
• Trauma

Question 31

When should you check ketones?

Answer 31

When BGL’s are >15 mmol/L

Question 32

Key management for DKA:

Answer 32

Start IV fluid replacement
Start IV insulin
Admit HDU
Check potassium and sodium

Question 33

What is the key management of hypoglycaemia?

Answer 33

Check BGL, Give simple sugars, wait ten minutes and then recheck BGL. If under 4 mmol/L recheck.