Diabetes

Question 1

What happens in the body to manage blood glucose levels?

Answer 1

When blood glucose increase e.g. eating

• beta cells in pancreas secrete insulin
• insulin lowers blood glucose

When the blood glucose levels are low…

• pancreases detects this. alpha cells in panaceas secretes glucagon
• liver converts glycogen to glucose = raises blood glucose levels

Question 2

What is type 1 DM?

Answer 2

Problem with insulin secretion

Question 3

What is type 2 DM>

Answer 3

Problem with insulin resistance

Question 4

What is the treatment + management for type 2 diabetes?

Answer 4

lifestyle modification

• improves bodies ability to regulate blood glucose
  
  • increases insulin secretion + decreases insulin resistance
• exercise reduces insulin resistance

Metformin (biguanides)

• increases peripheral insulin sensitivity
• decreases action of glycogen in the liver
• reduces intestinal absorption of glucose = decreases amount available to enter bloodstream
• side effects - lactic acidosis

Thiazolididiones (TZDs)
- Activate receptor responsible for increasing insulin sensitivity in adipose + liver cells = indirectly increase insulin sensitivity

Sulfonylureas
- Inhibit potassium channels on beta cells within pancreas = potassium builds up in the cell = depolarises cell membrane = opens voltage gate calcium channels = influx of calcium into beta cells = triggers release of insulin into blood stream

Incretins e.g. GLP-1

• Directly stimulate release of glucose from beta cells in pancreas
• Inhibit release of glucagon

Treatments that affect insulin production mechanism should be given with a meal as could cause hypo.

Question 5

What is the clinical presentation of diabetic crisis?

Answer 5

• Asymptomatic
• infections
• fatigue
• blurred vision
• 4 Ps
  
  • Paresthesia (pins + needles)
  • Polydipsia (excessive thirst)
  • Polyuria (large volumes dilute urine)
  • Polyphagia (increased appetite)

Question 6

What are the MICROVASCULAR retinopathy effects if diabetes progresses and is left undiagnosed?

Answer 6

Retinopathy
- gylcoma
- cataract
Contractile cells called retinal pericytes help regulate blood flow within retina. Hyperglycaemia causes damage to these cells. Inability to metabolise glucose within these cells = osmotic damage.

Pre-proliferative diabetic retinopathy
- damage results in weakening of capillary walls + increased blood flow = formation of microaneurisms + hard exudate

Proliferative diabetic retinopathy
- blurry vision / floaters due to ischaemia to cells of retina. Retina produces growth factor to try and compensate = produces new blood vessels

Question 7

What are the MICROVASCULAR neuropathy effects if diabetes progresses and is left undiagnosed?

Answer 7

Neuropathy

peripheral neuropathy

• decrease / increase in pain sensation
• painless injury
• decrease in reflex

Autonomic

• resting tachy
• urinary freq
• erectile dysfunction

Question 8

What are the MICROVASCULAR Nephropathy effects if diabetes progresses and is left undiagnosed?

Answer 8

Stages of nephropathy

• increased glomerular filtration rate (GFR)
• caused by increased pressure - caused by hypotension
• detectable proteinuria = mesangeal expansion = increases size of fenestration’s = becomes leaky = causes proteins to leak into urine (albumin in urine)
• decreased GFR = nephron ischaemia

Question 9

What are the MACROVASCULAR effects if diabetes progresses and is left undiagnosed?

Answer 9

Coronary heart

• chest pain
• CHF
• Dysphonea

Cerebrovascular

• Haemorrhage
• Cerebral infant
• Memory problems

Peripheral vascular

• Atherosclerosis
• Gangrean
• Ulceration

Question 10

What are the VASCULAR effects if diabetes progresses and is left undiagnosed?

Answer 10

• Atherosclerosis
• Arteriosclerosis
• Inflammation

Question 11

Who do diabetics need to see if they develop ulcers?

Answer 11

Chiropodist.

Referral back to diabetic nurse if diabetes is poorly controlled.