Diabetes and Drug Management Flashcards
What is the function of insulin?
To control blood glucose by moving glucose out of the blood stream into tissues mainly hepatocytes and muscles first then adipose tissue
Promotes protein synthesis and regulates metabolism in muscle cells
Inhibits the breakdown of fats
Where is insulin produced
In the B cells in the Islet’s of Langerhans located in the pancreas
Outline insulin synthesis
Precursor molecule produced form a single gene (proinsulin)
proinsulin cleaved into a and B chains linked by a disulphide bridge
further cleavage to produce active insulin a peptide hormone as well as a C polypeptide (no known function is excreted in the urine)
How can urine testing be done to diagnose diabetes
isn’t the best test and isn’t sensitive enough or specific
any glucose present in the urine should be investigated further as it could be an indication of diabetes
What is the random blood glucose level test?
Blood glucose taken 1/2 hour after last meal should be below 11.1 mmol/L for a health individual is above or equal to in diabetics
What is the fasting blood glucose test?
Patient is starved for 8 hours only water
should be less than 5.5 mmol/L for a healthy person diabetics will be greater or equal to 7.0 mmol/L
What is the HBA1c test?
Why is it so good?
What levels indicate diabetes?
When can you diagnose someone with diabetes?
measure glycated haemoglobin levels in the blood giving average blood glucose level over the past 10wks
over 48mmol/mol indicated diabetes
42 mmol/mol indicated pre-diabetes
If the test is over 48 mmol/mol and they have symptoms you can diagnose as diabetic
if they don’t have diabetes another test must be done
What is type I diabetes
Absolute insulin deficiency no insulin is being produced due to an autoimmune disease destroying B cells in the pancreas
Typical characteristics of type I
Can occur at any age
typically found in children
People tend to be normal weight slim
onset is usually dramatic
family history is less common
What are the main symptoms of type I diabetes?
tiredness weight loss more frequent infections polyuria polydipsia blurred vision hyperglycaemic coma
What are the main clinical presentations indicating type I
Presence of ketones in the urine due to fatty acid metabolism
no insulin present fat stores are broken down
Why are ketones present in the urine of type I diabetics?
What can be tested for and what can be an easy sign in poorly managed type I
absence of insulin triglycerides are broken down to fatty acids and glycerol
some fatty acids are used in TCA cycle to generate ATP majority converted to acetoacetate in ketone pathway
B hydroxybutyrate can be detected in the urine as well as acetone in the breath (pear drop smell)
What is type II diabetes
Insulin resistance
due to insulin receptors not working as they should (desensitised)
Or due to B cell dysfunction meaning insulin is no gradually no longer produced over a long period of time
What are the characteristics of type II
Slow onset
associated with increased age and obesity
no ketones are present in the urine
there is a genetic predisposition
Symptoms of type II
tiredness weight loss more frequent infections polyuria polydipsia blurred vision hyperglycaemic coma
Treatment of type I
Insulin injections
Insulin is essential to maintain life
long acting insulin given to maintain a basal level
as well as fast acting insulin after meals
also manage diet
Type II treatment
Lifestyle changes managing diet and increasing exercise
Drugs
insulin injections eventually
What other factors occur due to hyperglycaemia?
Increased blood pressure
Increased lipid cholesterol levels in blood
