Diabetes

Question 1

GLUT - 4

Answer 1

Skeletal muscles, adipose

Insulin dependent glucose transport)

Question 2

GLUT - 3

Answer 2

Neurones, placenta

High affinity transport (insulin independent)

Question 3

GLUT - 2

Answer 3

Kidney, small intestine, liver, pancreatic B - cells

Low - affinity transport (insulin independent)

Question 4

GLUT - 1

Answer 4

Endothelium, erythrocytes
Basal transport (insulin independent)

Question 5

Insulin effects on liver

Answer 5

Glucose uptake thus decrease gluconeogenesis
Increase Glycogenesis thus decrease glycogenolysis
Lipogenesis

Question 6

Insulin effects on adipose tissue

Answer 6

Glucose uptake
Increase Lipogenesis
Thus decrease lipolysis

Question 7

Insulin effects on muscle tissue

Answer 7

Increase Glucose uptake
Increase Glycogenesis
Increase protein synthesis thus decrease protein catabolism

Question 8

Normal metabolism blood glucose

Answer 8

F - < 5.5
PP - < 7.8
R - < 11.1

Question 9

Impaired fasting glucose blood glucose

Answer 9

F - 5.5-6.9
PP - < 7.8
R - < 11.1

Question 10

Impaired glucose tolerance blood glucose

Answer 10

F - < 7
PP - 7.8-11.1
R - < 11.1

Question 11

Diabetes blood glucose

Answer 11

F - > 7
PP - > 11.1
R - > 11.1

Question 12

Impaired fasting glucose VS Impaired glucose tolerance

Answer 12

IFG - predominantly hepatic insulin resistance - continuous output of glucose
IGT - muscle resistance and impaired post prandial insulin release

Question 13

What is HBA1C

Answer 13

Glycated haemoglobin, haemoglobin that has become glycosylated. Formation of HBA1C occurs proportionately to plasma glucose levels.

Question 14

Advantages of HBA1C test

Answer 14

easier for patient, don’t have to fast

AVERAGE - less influenced by small fluctuation

Question 15

Disadvantages of HBA1C test

Answer 15

cannot be done on patients with blood disease ie SCA
This is an AVERAGE over 3 months, thus if there have been recent changes suggesting issues with blood glucose they will be out average by the healthy past few months.
Less SPECIFIC - cant distinguish IFG or IGT.

Question 16

Why is metformin used as a first line agent to treat diabetes?

Answer 16

Oral 
Doesn't cause weight gain
Low risk of hypoglycaemia
Cheap
Reduces heart disease
Usually well tolerated

Question 17

Metformin method of action

Answer 17

Decreasing glucose production of liver, generally increases insulin sensitivity of body tissues, increases translocation of GLUT - 4 into membrane.

Question 18

2 main problems in diabetes and their consequences

Answer 18

Insulin resistance and impaired B cell function - high blood glucose and high free fatty acids

Question 19

Diabetes risk factors

Answer 19

Overweight 
Poor diet
Sedentary lifestyle 
Family history
Race
Age 
High blood pressure

Question 20

Microvacular complications of Diabetes

Answer 20

Damage to small blood vessels:
Retinopathy
Kidneys - Nephropathy
Nerves - Neuropathy

Question 21

Macrovascular complications of Diabetes

Answer 21

Cardiovascular disease - heart attacks, strokes and insufficiency in blood flow to legs.

Question 22

Diabetic retinopathy ESDT

Answer 22

E - Blindness and visual disability
S - Blurred vision
D - Eye examinations
T - Good metabolic control can delay onset and progression.
And early detection.

Question 23

Nephropathy ESDT

Answer 23

E - Kidney failure
S - Tired, anemic, electrolyte imbalance, can’t think clearly.
D - Urine test / kidney function blood test
T - control of high BG, BP, restriction of protein

Question 24

Neuropathy ESDT

Answer 24

E - Nerve damage, sensory loss, damage to limbs, impotence
S - numbness and pain in extremities, impotence, decreased sensation can lead to damage and foot infections.
D - regular examinations for symptoms
T - blood glucose controlled to prevent / delay

Question 25

Diabetic Foot Disease

Answer 25

due to changes in blood vessels and nerves leads to ulceration and subsequent limb amputation.
T - regular inspection and good care ie footwear etc

Question 26

Diabetic cardiovascular disease

Answer 26

Hyperglycaemia causes atherosclerosis. Decreased flow to heart, brain, extremities - pain and decreased healing from infections.
S - ranging, chest - leg pain, confusion, paralysis.
D - detection of smoking, high BP, high cholesterol and obesity are more important.
T - controlling risk factors with BG