Diabetes mellitus

Question 1

Explain insulin

Answer 1

A peptide hormone that is produced in the beta cells of the islets of Langerhans of the pancreas.
Regulate glucose uptake into cells- no insulin means too much blood glucose.

Question 2

What are the actions of insulin?

Answer 2

Uptake of glucose and amino acids by the cells.
Increased glycogen synthesis and fatty acid synthesis.
Decreased lipolysis, proteolysis and gluconeogensis.

Question 3

What controls insulin release?

Answer 3

Mainly negative feedback- glucose transported GLUT2.
Some autonomic control.
Also released by cholecystokinin.

Question 4

What are the acute consequences of an insulin deficiency?

Answer 4

Hyperglycaemia
Ketosis
Aciodosis
Hyper molar state.

Question 5

What are the chronic consequences of an insulin deficiency?

Answer 5

Cardiovascular disease
Nephropathy
Neuropathy
Retinopathy.

Question 6

Explain diabetes mellitus type 1

Answer 6

Autoimmune destruction of beta cells.
Starts in childhood
Dependent of the HLA gene subtype.

Question 7

Explain T2DM.

Answer 7

Peripheral insulin resistance.

Insulin concentrations remain normal or high.

Question 8

Explain gestational diabetes.

Answer 8

Genetic predisposition.
Insulin resistance- probably triggered by hormonal changes in pregnancy.
Resolves with delivery.

Question 9

What are the risk factors of gestational diabetes in the mum?

Answer 9

Maternal age. 
Family history of T2DM. 
African or North American native. 
Previous gestational diabetes. 
Previous baby over 4Kg.
Smoking.

Question 10

What are the dangers of gestational diabetes in the child?

Answer 10

Risk of T2Dm in later life.
Risk of obesity in later life. 
Macrosomia. 
Neonatal hypoglycaemia. 
Neonatal jaundice. 
Respiratory distress syndrome.

Question 11

What are the dangers of secondary diabetes mellitus?

Answer 11

Chronic pancreatits.
Cystic fibrosis
Pancreatic surgery. 
Haemachromatosis. 
Endocrine disease- cushings syndrome. 
Corticosteriods.

Question 12

What are the symptoms of DM1.

Answer 12

Polyruia.
Polydipsia (thirst).
Hunger
Weight loss.

Question 13

What are the blood glucose levels of DM?

Answer 13

Fast glucose at 7.0mmol/l.

Random level or two hours after eating- 11.1mmol/l.

Question 14

What are the acute presentations of DM?

Answer 14

Ketoacidosis (DM1 and rarely D2)
Hyperosmolar state- due to severe dehydration in T2DM.
Hypoglycaemia- due to an insulin overdose.
Diabetic foot.

Question 15

What are the chronic presentations of DM

Answer 15

Macrovascluar- ischemic heart disease, stroke, peripheral vascular disease.
Microvascular- retinopathy, neuropathy and nephropathy.
Cataract.

Question 16

Explain diabetic retinopathy.

Answer 16

Proliferation of blood vessels in the retina.

Macular oedema leading to fluid in retina.

Question 17

What are the clinical symptoms of diabetic nephropathy?

Answer 17

Chronic renal failure.

Hypertension.