Diabetes and Hypoglycaemia

Question 1

What happens during the fed state?

Answer 1

Question 2

What happens in the fasting state?

Answer 2

Question 3

How is plasma glucose level regulated?

Answer 3

Question 4

What is the role of insulin?

Answer 4

Question 5

What are the functions and metabolic paths of the hormones in plasma glucose level regulation?

Answer 5

Question 6

What is diabetes mellitus?

Answer 6

= metabolic disorder characterised by chronic hyperglycaemia and associated abnormalities of lipid and protein metabolism

Question 7

What is type 1 diabetes?

Answer 7

• Deficiency in insulin secretion
• childen and young adults - sudden onset
• cause = autoimune destruction of B-cells
  
  • starts with autoantigen formation presented to T-lymphocytes to imitate autoimmune response –> produces islet cell antibodies
  • causes hyperglycaemia due to absolute deficiency of both insluin and amylin which lowers blood glucose by supressing glucagon output from pancreatic cells

Question 8

What are the genetic predisposition and enviromental factors of type 1 diabetes?

Answer 8

Question 9

What are the metabolic complications of type 1 diabetes?

Answer 9

Question 10

What is type 2 diabetes?

Answer 10

• Insulin secretion is retained but there is target organ resistance to its actions
• Slow onset, middle-aged - linked with exercise and obesity

Question 11

What are genetic predisposition and lifestye factors of type 2 diabetes?

Answer 11

Question 12

How can you test for type 2 diabetes?

Answer 12

As well as symptoms you will be diagnosis by oral glucose tolerance test or testing the random plasma glucose levels

• Impaired glucose tolerance
• Imparied fasting glycaemia

Without symptoms, diagnosis will follow test blood samples on 2 separate days

Oral glucose tolerance test:

• checks body’s ability of metabolizing glucose

Question 13

What are the different types of diabetes?

Answer 13

1. Type 1
2. Type 2
3. Secondary - chronic pancreatitis, pancreatic surgery
4. Gestational - occurs for the first time in pregnnacy

Question 14

How do you monitor glycaemic control?

Answer 14

• to prevent complications or avoid hypoglycaemia
• Self-monitor capillary blood measurement and urine anaylsis
• Every 3-4 months check of blood HbA1c
• Urinary albumin

Question 15

What are the long-term complications of diabetes?

Answer 15

Micro-vascular disease - retinopathy, nephropathy

Macro-vascular disease - atherosclerosis heart attack/stroke

Question 16

What is hypogluycaemia?

Answer 16

can occur in patients with and without diabetes

Plasma glucose less than 2.5mmol/L

Without having diabetes:

• Caused by drugs like alcohol
• Endocrine diseases can cause it
• Inherited metabolic disorders
• Insulinoma

Question 17

What is reactive hypoglycaemia?

Answer 17

= hypos after eating

Drop in blood sugar usually recurrent and occur within 4 hours after eating

Cause is unclear:

• Benign tumour in pancreas could cause overproduction of insulin
• Too much glucose may be used up by the tumour
• Deficiencies in counter-regulatory hormones

Question 18

What is the counter-regulatory response of hypoglycaemia?

Answer 18

Question 19

What are the signs and symptoms of hypoglycaemia?

Answer 19

Neurogenic

• Triggered by falling glucose levels
• Activated by ANS and mediated by sympathoadrenal release of carecholamines and Ach
• Mood changes, paleness, sweating, hunger, tiredness, headaches

Neuroglycopenia

• Due to neuronal glucose deprivation
• Confusion, difficulty speaking, paraesthesia, seizures, coma and death