Diabetes

Question 1

What is type 1 diabetes?

Answer 1

Autoimmune disease, T cells in the body attack the beta cells of the pancreas, body cannot produce insulin due to beta cell destruction and results in hyperglycaemia

Question 2

What are the signs and symptoms of Type 1 diabetes?

Answer 2

Polyuria, polydipsia, polyphasia, lethargic, fatigue, dehydrated, ketosis, hyperglycaemia, nausea, vomiting, blurry vision

Question 3

What is type 2 diabetes?

Answer 3

It is characterised by insulin resistance. Beta cells in the body able to produce insulin but the cells in the body are not responding to it

Question 4

What are the risk factors of Type 1 diabetes?

Answer 4

Genetic predisposition and environmental triggers

Question 5

What are the risk factors of type 2 diabetes?

Answer 5

Genetics, obesity, hypertension and increasing age, race, previous history of gestational diabetes

Question 6

What are the signs and symptoms of type 2 diabetes?

Answer 6

No overt symptoms, reoccurring infection, hyperglycaemia

Question 7

Does type 1 and type 2 diabetes require exogonous insulin therapy?

Answer 7

Type 1 requires insulin therapy due to beta cell destruction. Some type 2 may require insulin as their condition progresses

Question 8

Do those with type 1 diabetes need a strict diet?

Answer 8

No. Goal is to balance insulin with their food preferences and exercise patterns.

Question 9

What is the onset of type 1 diabetes?

Answer 9

Common in childhood

Question 10

Why does hyperglycaemia increase the likelihood of ischemic stroke?

Answer 10

Due to macrovascular changes caused by dyslipidaemia, arteriosclerosis and increased platelet aggregation caused by hyperglycemia

Question 11

What is diabetic dermopathy?

Answer 11

It is small, round, brown atropic skin lesions that occur kn the shins. Common in older adults and those with longstanding diabetes. It is associated with other microvascular complications of diabetes.

Question 12

Why does diabetes cause atherosclerosis?

Answer 12

Chronic hyperglycemia is associated with hypertriglyceridemia, low HDL and high LDL. There is a greater prevalence of coronary disease for those with diabetes

Question 13

Are diabetics at risk of coronary artery disease?

Answer 13

Yes, due to macrovascular complications. Even with good glycemic control those with diabetes are at greater risk.

Question 14

What is diabetic nephropathy?

Answer 14

It is an increase gfr due to increased pressure state caused by hypertension and efferent vasoconstriction. Increased pressure caused mesangial expansion causing detectable preoteinuria-albumin, and mesangial expansion caused the release of cytokines and oxygen free radicals that cause inflammation and damage the cells that support the nephron. Decreased gfr filtration rate is cause by the ischema and atrophy.

Question 15

What is peripheral neuropathy?

Answer 15

Caused by hyperglycemia causes the axon of the neurons to die back damaging nerve fibres. This results in the loss of vibration sensation, altered proprioception and impairment of senses of pain, light touch and temperature

Question 16

What is neurogenic bladder?

Answer 16

Caused by autonomic neuropathy. The retention of urine in the bladder increase the risk of UTI

Question 17

Why do diabetics have an increased risk for infections?

Answer 17

White cell recruitment ability to kill bacteria snd cell mediated immunity are depressed in diabetic with hyperglycemia

Question 18

Peripheral vascular disease

Answer 18

Diabetics have increased lipid abnormalities which results in atherosclerosis. This causes decreased perfusion to the peripheries, decreased wound healing and gangrene

Question 19

What is metformin, glipizide snd thiazilidinedones for?

Answer 19

Address insulin resistance by increasing cellular uptake of glucose and or improving cellular insulin sensitivity

Question 20

What does sulfonylureas ie glipizide, DP-4 inhibitors ie stagliptin and glucacon like peptide 1 receptor agonist ie exentide do?

Answer 20

They increase insulin production by stimulating beta cells or mediating factors that are preventing beta cell response to glucose levels and and decrease hepatic glucose production

Question 21

What dooes alpha-glucosidase inhibitor is acarbose and glucagon-like peptide 1 receptor agonist ie exentide do?

Answer 21

Reduce blood glucose levels by delaying carbohydrate digestion

Question 22

What causes hypos?

Answer 22

• not eating enough food
• not eating enough carbohydrates with meals
• missing or delaying a meal
• missing snacks if they are part of food plan
• introducing a regular exercise routine without making adjustments to the diabetes tablets
• taking too much insulin or sulphonyurea tablets
• losing weight without seeing doctor to reduce medication
• drinking alcohol in excess or without taking carbohydrate food

Question 23

What are the three steps to manage hypos?

Answer 23

Step 1: eat or drink one serving of quick acting carbohydrate (4-5 dextrose energy, 4-5 glucose tabs, 7-8 jellybeans, 3 teaspoons of glucose powder, small glass of fruit juice or sugar sweetened soft drink, 3 teaspoons of honey or jam
Step 2:after 10 minutes, test you bsl level again, if still less than 4mmol/L, eat another serving of quick acting carbohydrate
Step 3: once blood sugar is above 4mmol/L follow up with substantial carbohydrate meal

Question 24

How can you monitor diabetes?

Answer 24

• HbA1C
• self glucose monitoring
• diabetic foot exams
• diabetic retinopathy
• urine testing for microalbuminuria
• weight and BMI