Diabetes Clinical Demonstration

Question 1

What is carbohydrate

• stored as
• circulates as
• metabolised as

Answer 1

• Stored as glycogen
• Circulating as glucose
• Metabolised as glucose

Question 2

What is lipids

• stored as
• circulates as
• metabolised as

Answer 2

• Stored as triglyceride
• Circulates as Non-esterfified fatty acids (NEFA), ketones, triglyceride
• Metabolised as NEFA, ketones

Question 3

what is the most important fact that causes the switch between using glucose and lipids as an energy source

Answer 3

• insulin

Question 4

What is the energy supply mostly derived from when you are in the fasting state

Answer 4

• Most energy supply coming from lipid oxidation

Question 5

is insulin high or low in the fasting state and what is the plasma glucose level

Answer 5

low insulin

- normal plasma glucose is 5 mmolar

Question 6

describe what is being metabolised in the fasting state

Answer 6

• 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

Question 7

what is activated in the fasting state

Answer 7

• Some ‘stress’ (hormones e.g. cortisol & sympathetic) – increase with prolonged fast

Question 8

when is the fed state

Answer 8

1-2 hours after a meal

Question 9

Where is the most energy supply coming from in the fed state

Answer 9

• Most energy supply coming from glucose

Question 10

is insulin high or low in the fed state and what is the plasma glucose like

Answer 10

• High insulin

* Plasma glucose 7-8 mmolar

Question 11

describe what happens to glucose and fatty metabolism for insulin

Answer 11

• 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

Question 12

how is increased fuel met when you need it in exercise

Answer 12

• Increased fuel needs met by increased oxidation of both lipid and glucose

Question 13

what is insulin and plasma level in glucose

Answer 13

• Low insulin

* Normal plasma glucose 5 mmolar

Question 14

what is metabolised in exercise

Answer 14

• 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

Question 15

How does ketoacdisois happen

Answer 15

• 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

Question 16

What fuels are used in the brain

Answer 16

• Brain, glucose under all conditions. Aerobic only. (ketones during starvation only)

Question 17

what fuels does red blood cells and skin use

Answer 17

• RBC & skin anaerobic glucose only

Question 18

what fuels does skeletal muscle use

Answer 18

• 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)

Question 19

How much insulin is produced per day

Answer 19

• About 30 units of insulin per day

Question 20

what causes an increase in insulin requirement

Answer 20

• Insulin requirement increased in obesity or couch potatoes, less in active, fit people

Question 21

What is the percentage of beta cell function left in diabetes

Answer 21

• Diabetes always <30% of beta-cell function left, Type 1 usually about 10% when they present, usually <5% in most patients

Question 22

what is type 1 diabetes

Answer 22

• autoimmune condition in which insulin is completely deficient and is not really present
• it is absolute

Question 23

what is type 2 diabetes

Answer 23

• 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

Question 24

what causes type 1 diabetes

Answer 24

• Autoimmune destruction of beta-cells in islets of Langerhans in pancreas
• Familial, some genetics sorted out (cell surface antigens & immune response elements)

Question 25

what is the age group where type 1 diabetes is diagnosed

Answer 25

• Any age, most common about 7-13 years

Question 26

what is the prevalence of diabetes in the caucasian population

Answer 26

• Prevalence 0.2 of caucasian population (increasing recently)

Question 27

what is the presentation of type 1 diabetes

Answer 27

• 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

Question 28

what are the differences between type 1 and type 2 diabetes

Answer 28

• 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

Question 29

Name the day to day management of type 1 diabetes

Answer 29

• Monitor blood glucose level
• Replace insulin
• Eat regularly, timing and quantities
• Adapt to changes in exercise, food and other illnesses/stress

Question 30

How can you work out your glucose

Answer 30

• 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

Question 31

what are the two types of hypoglycaemic symptoms

Answer 31

• neuroglycopaenia

- sympathetic response

Question 32

what are the neuroglycopaenia symptoms of hypoglycaemia

Answer 32

Dizziness, visual disturbance, hunger
Confusion, personality change, aggression, goes quiet
Coma

Question 33

what is the sympathetic response symptoms of hypoglycaemia

Answer 33

Sweating, pallor, tremor, nausea

Question 34

what are the symptoms of high blood sugar

Answer 34

Just high blood sugar without acidosis or ketosis
thirsty, polyuria, nocturia, nausea
tired, infections

Question 35

what are the asymptomatic factors of high blood sugar (things that do happen but you don’t get symptoms for)

Answer 35

Renal & eye problems – specific to diabetes
Nerve problems – almost unique to diabetes
Blood vessel damage – similar to other atherosclerosis

Question 36

how does long acting insulin work

Answer 36

• this is supposed to give insulin throughout the day and try to mimic real insulin
• e.g. Levemir lasts 24 hours

Question 37

how does short acting insulin work

Answer 37

• given just 15 minutes before a meal,
• half life of 2 hours
• e.g. Humalog

Question 38

Describe how insulin pump works

Answer 38

• 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