Diabetes SEM 2

Question 1

What causes hyperglycaemia?

Answer 1

Defects in insulin production, action or both.

Question 2

Can chronic hyperglycaemia result in damage to organs?

Answer 2

Yes. E.g. eyes, vasculature and nerves.

Question 3

Classify the different types of hyperglycaemia.

Answer 3

Type 1-Immunologically mediated, Idiopathic.
Type 2.
Other-Gestational diabetes.

Question 4

Describe Type 1 Diabetes Mellitus.

Answer 4

The chronic disease of carbohydrate, protein and fat metabolism. Lack of insulin due to autoimmune beta cell destruction.

Question 5

Describe how type 1 Diabetes Mellitus comes to exist.

Answer 5

Lack of insulin due to autoimmune beta cell destruction. Culmination of lymphocytic infiltration and destruction. As beta cell mass declines, insulin secretion decreases. Viral infection in genetically predisposed individual acts as trigger. Moat common antibodies are directed as Glutamic Acid Decarboxylase (GAD) and Islet cell antibodies (IA2).

Question 6

Which age group is type 1 diabetes mellitus most common in?

Answer 6

Juveniles.

Question 7

What are the most common symptoms of type 1 diabetes mellitus?

Answer 7

Polyuria.
Polydipsia.
Polyphagia.
Fatigue.
Nocturnal enuresis.
Loss of weight with muscle wasting.

Question 8

What are the recommended steps to living with type 1 diabetes mellitus?

Answer 8

Diet.
Exercise program.
Lifelong insulin therapy.
Usually 2 or more subcutaneous insulin injections daily.
Self monitoring blood glucose levels.

Question 9

Describe the existence of type 2 diabetes mellitus.

Answer 9

Results from a combination of inadequate insulin secretion or resistance to insulin action or inappropriate and excessive glucagon secretion.

Question 10

What are the two main factors contributing to type 2 diabetes?

Answer 10

Genes and lifestyle & diet.

Question 11

The combination of genes and lifestyle factors results in what malfunction in the body?

Answer 11

Insulin resistance.

Question 12

What two types of malfunctions may exist due to insulin resistance?

Answer 12

Normal b-cell function and Abnormal B-cell function.

Question 13

What are the effects of Normal B-cell function resulting from insulin resistance?

Answer 13

Compensatory hyperinsulinemia and normoglycemia.

Question 14

What are the effects of Abnormal B-cell function?

Answer 14

Relative insulin deficiency, hyperglycemia and Type 2 Diabetes.

Question 15

What are some of the modifiable risk factors to type 2 diabetes?

Answer 15

Obesity, sedentary lifestyle, previously identified glucose intolerance, metabolic syndrome, dietary syndrome, intrauterine environment, smoking.

Question 16

What are some of the nonmodifiable risk factors to type 2 diabetes?

Answer 16

Ethnicity (African-American, Native American, Asian-American, or Pacific Islander), family history of type 2 diabetes, age, gender, history of gestational diabetes, polycystic ovary syndrome, inflammation.

Question 17

What are some of the long-term complications of diabetes?

Answer 17

Microvascular (neuropathy, nephropathy, retinopathy) and macrovascular (CVD, hypertension, dyslipidemia).

Question 18

Describe the onset of type 1 diabetes.

Answer 18

Sudden onset, at any age (mostly young), thin or normal size.

Question 19

Describe the onset of type 2 diabetes.

Answer 19

Gradual onset, mostly in adults, often obese adults.

Question 20

Is ketoacidosis common or rare in type 1 diabetes?

Answer 20

Common.

Question 21

Is ketoacidosis common or rare in type 2 diabetes?

Answer 21

Rare.

Question 22

What are the levels or endogenous insulin in type 1 diabetes?

Answer 22

Low or absent.

Question 23

What are the levels of endogenous insulin in type 2 diabetes?

Answer 23

Absent.

Question 24

Describe diabetic ketoacidosis.

Answer 24

Diabetic ketoacidosis is an acute, life threatening complication which includes a disordered metabolic state with hyperglycaemia, ketone formation, acidosis and ketonuria.

Question 25

What are the common symptoms of diabetic ketoacidosis.

Answer 25

Malaise and fatigue, nausea and vomiting, abdominal pain, rapid LOW, confusion or even comatose, signs of dehydration, characteristic acetone (ketotic) breath odor.

Question 26

What management for diabetic ketoacidosis is recommended?

Answer 26

Rehydration, Insulin therapy, Electrolyte repletion, Management of complications and evaluation of therapy, Treat possible precipitant particularly infections.

Question 27

What is the leading cause of bacterial infection in diabetic ketoacidosis.

Answer 27

Klebsiella pneumonia.

Question 28

What does the abbreviation HHS stand for?

Answer 28

Hyperosmolar Hyperglycaemic State.

Question 29

Describe HHS and the characteristic of the disease.

Answer 29

Commonly in type 2 diabetics with reduced fluid intake.
Common precipitant are illness, altered mental state, drugs, PE, or MI and CVAs.
Characterised by hyperglycaemia, hyperosmolarity, dehydration and absence of ketoacidosis.

Question 30

Describe the approach to management of HHS.

Answer 30

Fluids (deficit of 11-12L; 1L normal saline bolus; 1L every 2-4 hours; watch sodium levels), Long term therapy, Insulin and electrolytes.