Diabetes and Hypoglycaemia

Question 1

What are 4 complications of insulin therapy?

Answer 1

1) Hypoglycaemia
2) Lipohypertrophy
3) Insulin resistance and weight gain
4) Life style interference –> Weight Gain

Question 2

What are the problems found with insulin in T2DM?

Answer 2

Insulin Secretion

Insulin Resistance

Question 3

What is the aetiology of T2DM?

Answer 3

1) Genetic Predisposition

2) Environmental Factors (Weight, Exercise and Lifestyle)

Question 4

Why is insulin secretion not functional in type 2 diabetes?

Answer 4

There is lipid deposition in the IOL in pancreas causing impairment of insulin secretion

Question 5

Describe the pathophysiology of T2DM?

Answer 5

1) Impaired insulin secretion and increased resistance
2) Impaired Glucose Tolerance (Above normal levels) (IGT)
3) ^ FFAs and Hyperglycaemia

Question 6

What is the driving force of hyperglycaemia in T2 diabetes?

Answer 6

Hepatic Insulin Resistance

Question 7

What are 3 risk factors of T2 diabetes?

Answer 7

1) Family History
2) Obesity
3) Physical Inactivity –> Sedentary Lifestyle

Question 8

What happens to insulin secretion, resistance and glucose levels in type 2?

Answer 8

Sec: Decreases
Resistance: Increases
GL: Increase

Question 9

Why is diabetic ketoacidosis rarely seen in type 2?

Answer 9

Body still contains low plasma insulin levels, which can reduce chance of ketogenesis and muscle catabolism

Question 10

What is the treatment procedure for treating type 2?

Answer 10

1) Change lifestyle –> Diet, exercise, weight etc.
2) Metformin
3) Metformin and Sulphonylurea
4) Metformin, sulphonylurea and insulin
5) Insulin dose increased as required

Question 11

How do the two treatment methods work for treating type 2?

Answer 11

1) M: Increase insulin sensitivity, inhibit glucose production
2) S: Stimulates insulin release

Question 12

What is a potential adverse effect of sulphonylurea?

Answer 12

Hypoglycaemia

Question 13

What are 3 microvascular complications of diabetes?

Answer 13

1) Diabetic Nephropathy
2) Diabetic Retinopathy
3) Diabetic peripheral neuropathy

Question 14

What is a macrovascular complication of diabetes?

Answer 14

Stroke and CVS

Question 15

What are the complications of acute and chronic hyperglycaemia?

Answer 15

A: Diabetic ketoacidosis and hyperosmolar coma
C: Micro and macrovascular tissue complications

Question 16

What is the most common form, clinical consequences and pain associated with diabetic neuropathy?

Answer 16

F: Distal symmetrical polyneuropathy
CC: Pain, Autonomic neuropathy, Insensitivity
P: Burning, Paraesthesia, Nocturnal exacerbation

Question 17

What is autonomic neuropathy and what are 5 main signs?

Answer 17

Damage to the nerves that supply body structures that regulate functions such as BP, HR, bowel/bladder emptying.
1) Hypotension 2) HR affected 3) Diarrhoea 4) Incontinence 5) Erectile Dysfunction 6) Dry skin

Question 18

What are the consequences found of diabetic neuropathy?

Answer 18

Insensitivity -> foot ulceration -> infection -> amputation

Question 19

Where does insensitivity spread to in diabetic neuropathy?

Answer 19

Starts in the toes and moves up (proximally)

[ Glove and stocking distribution]

Question 20

What are 5 risk factors of diabetic neuropathy?

Answer 20

1) Poor glycaemic control
2) Hypotension
3) Overweight
4) Long duration of diabetes
5) Hb1AC
6) Smoking

Question 21

What are the treatments for diabetic neuropathy?

Answer 21

1) Antidepressants 2) Analgesic pain relief 3) Improvement in glycaemic control

Question 22

What are the signs of acute ischaemia? (Complication of PVD -> 6P’s)

Answer 22

1. Pulseless.
2. Pale.
3. Perishing cold.
4. Pain.
5. Paralysis.
6. Paraesthesia.

Question 23

Are there increased or decreased pulses in a diabetic neuropathic foot?

Answer 23

Increased

Question 24

What are the 5 risk factors and resultant pathophysiology from diabetic retinopathy?

Answer 24

1) Long term DM
2) Poor glycaemic control
3) Hypertension
4) Insulin treatment
5) Pregnancy
6) High HbA1c
Micro-aneurysms -> pericyte loss and protein leakage -> occlusion -> ischaemia.

Question 25

What are the 2 sub-classifications of diabetic retinopathy?

Answer 25

1) Proliferative: Neovascularisation in the retina

2) Non-Proliferative

Question 26

What are the 3 types and symptoms of Retinopathies?

How is it treated?

Answer 26

R1: Non-Proliferative: Exudate, intraretinal haemorrhages, micro-aneurysms
R2: Pre-Proliferative: Venous beading and growth of new vessels
R3: Proliferative: New blood vessel on disc
T: Regular screening to assess visual acuity –> Laser therapy to treat neovascularisation

Question 27

Describe the basic pathology of diabetic nephropathy?

Answer 27

Progressive decline in renal function and proteinuria

Question 28

What happens to basement membrane in DN?

Answer 28

Thickening of the glomerular basement membrane

Question 29

How does DN differ in the two types of DM?

Answer 29

T1: microalbuminuria after 5-10 years
T2: Microalbuminuria found at diagnosis

Question 30

How is DN treated?

Answer 30

1. Glycaemic and BP control.
2. ARB/ACEi.
3. Proteinuria and cholesterol control.

Question 31

What are 5 main symptoms of hypoglycaemia?

Answer 31

1) Sweating
2) Shaking
3) Hunger
4) Tachycardia
5) Anxiety

Question 32

What drug classes can cause diabetes?

Answer 32

1) Thiazides
2) Steroids
3) Anti-psychotics