Diabetes Clinical Demonstration Flashcards
What is carbohydrate
- stored as
- circulates as
- metabolised as
- Stored as glycogen
- Circulating as glucose
- Metabolised as glucose
What is lipids
- stored as
- circulates as
- metabolised as
- Stored as triglyceride
- Circulates as Non-esterfified fatty acids (NEFA), ketones, triglyceride
- Metabolised as NEFA, ketones
what is the most important fact that causes the switch between using glucose and lipids as an energy source
- insulin
What is the energy supply mostly derived from when you are in the fasting state
• Most energy supply coming from lipid oxidation
is insulin high or low in the fasting state and what is the plasma glucose level
low insulin
- normal plasma glucose is 5 mmolar
describe what is being metabolised in the fasting state
- No glucose being stored, glucose being mobilised from glycogen
- Glucose being metabolised by brain, red blood cells & skin
- High plasma fatty acids being oxidised by most other tissues
what is activated in the fasting state
• Some ‘stress’ (hormones e.g. cortisol & sympathetic) – increase with prolonged fast
when is the fed state
1-2 hours after a meal
Where is the most energy supply coming from in the fed state
• Most energy supply coming from glucose
is insulin high or low in the fed state and what is the plasma glucose like
- High insulin
* Plasma glucose 7-8 mmolar
describe what happens to glucose and fatty metabolism for insulin
- Most glucose being stored as glycogen (but oxidation also increases)
- Low fatty acids
- Glucose being taken up by skeletal muscle (& metabolised by brain, red blood cells, skin as before)
- Low stress hormones
how is increased fuel met when you need it in exercise
• Increased fuel needs met by increased oxidation of both lipid and glucose
what is insulin and plasma level in glucose
- Low insulin
* Normal plasma glucose 5 mmolar
what is metabolised in exercise
- No glucose being stored, glucose being mobilised from glycogen
- High fatty acids
- Glucose being metabolised by skeletal muscle, brain, red blood cells, skin & others.
- Aerobic & anaerobic .
- High ‘stress’ hormones
How does ketoacdisois happen
- Ketone bodies of keto acids caused when you release fatty acids but don’t oxidise them completely
- Get partial oxidation and ketone bodies build up
- Get ketoacidosis
What fuels are used in the brain
• Brain, glucose under all conditions. Aerobic only. (ketones during starvation only)
what fuels does red blood cells and skin use
• RBC & skin anaerobic glucose only
what fuels does skeletal muscle use
• Skeletal muscle (cardiac muscle similar) – this can change
– Resting state, mostly fatty acids,
– Exercise state, mostly fatty acids (but glucose oxidation increases too)
– Fed state, glucose
(can do both aerobic & anaerobic)
How much insulin is produced per day
• About 30 units of insulin per day
what causes an increase in insulin requirement
• Insulin requirement increased in obesity or couch potatoes, less in active, fit people
What is the percentage of beta cell function left in diabetes
• Diabetes always <30% of beta-cell function left, Type 1 usually about 10% when they present, usually <5% in most patients
what is type 1 diabetes
- autoimmune condition in which insulin is completely deficient and is not really present
- it is absolute
what is type 2 diabetes
- a condition in which insulin is deficiency or there is a resistance to insulin
i. e. may still be making 40 units per day, but need more - it is relative
what causes type 1 diabetes
- Autoimmune destruction of beta-cells in islets of Langerhans in pancreas
- Familial, some genetics sorted out (cell surface antigens & immune response elements)
what is the age group where type 1 diabetes is diagnosed
• Any age, most common about 7-13 years
what is the prevalence of diabetes in the caucasian population
• Prevalence 0.2 of caucasian population (increasing recently)
what is the presentation of type 1 diabetes
- Younger
- More suddnely – type 1 30% present as emergency, less than 5% for type 2s prevent as emergency
- More weight loss – much more a feature of type 1
- Polyuria
- Increased thirst
- Increase hunger
- Never have diabetic tissue damage at presentation
what are the differences between type 1 and type 2 diabetes
- Younger than type 2 diabetes
- More suddnely – type 1 30% present as emergency, less than 5% for type 2s prevent as emergency
- More weight loss – much more a feature of type 1
- Never have diabetic tissue damage at presentation – because it comes on suddenely but because type 2 have had high sugars for a long time before it is spotted they have damage from the high blood pressure
Name the day to day management of type 1 diabetes
- Monitor blood glucose level
- Replace insulin
- Eat regularly, timing and quantities
- Adapt to changes in exercise, food and other illnesses/stress
How can you work out your glucose
- glucose monitoring system - abbots freestyle libre
- have a sensory application and sensory pack, uses the sensor pack and get a blood prick and then place this in the machine and it measures it on the reader
- can also get an app and sensor to do this
what are the two types of hypoglycaemic symptoms
- neuroglycopaenia
- sympathetic response
what are the neuroglycopaenia symptoms of hypoglycaemia
Dizziness, visual disturbance, hunger
Confusion, personality change, aggression, goes quiet
Coma
what is the sympathetic response symptoms of hypoglycaemia
Sweating, pallor, tremor, nausea
what are the symptoms of high blood sugar
Just high blood sugar without acidosis or ketosis
thirsty, polyuria, nocturia, nausea
tired, infections
what are the asymptomatic factors of high blood sugar (things that do happen but you don’t get symptoms for)
Renal & eye problems – specific to diabetes
Nerve problems – almost unique to diabetes
Blood vessel damage – similar to other atherosclerosis
how does long acting insulin work
- this is supposed to give insulin throughout the day and try to mimic real insulin
- e.g. Levemir lasts 24 hours
how does short acting insulin work
- given just 15 minutes before a meal,
- half life of 2 hours
- e.g. Humalog
Describe how insulin pump works
- Insulin pump helps you to mimic pancreas
- can choose how much insulin you give
- chose when you give insulin - so for example it can give amount of insulin over several hours which is less damaging to the tissue than an insulin injection with a set amount at one time
- change the site every 3 days - there is a reservoir compartment which will last about 3 days
