disabetes

Question 1

what is type 1 diabetes

Answer 1

common in young
loss of beta cells due to autoimmune action
rapidly fatal if not treated (ketoacidosis)
treatment; insulin

Question 2

what is type 2 diabetes

Answer 2

usually older individuals
loss of beta cells, disorders of insulin secretion and tissue resistance to insulin
may not initially need treatment but when progress they do

Question 3

stages of diabetes type 1

Answer 3

found with human leukocyte antigen (HLA) marker and autoantibodies BUT no glucose/insulin abnormalities. go on to develop glucose tolerance and then diabetes

Question 4

stages of diabetes type2

Answer 4

insulin resistance initially and then insulin production falls and results in glucose tolerence. may loose all glucose production/ develop complete resistance to insulin

Question 5

cause of type 1 diabetes

Answer 5

killer lymphocytes, macrophages and antibodies attack and destroy beta cells. genetic predisposition is also a factors; HLADR3 ad HLADR4 - markers of this.
variation suggest viral triggers rapid deterioration

Question 6

symptoms of type 1

Answer 6

polyuria; v high glucose. not all can be reabsorbed meaning it stays in nephron so less water is reabsorbed
polydipsia; due to excess water loss
weight loss; fat and protein metabolised due to lack of insulin

Question 7

how to diagnose type 1

Answer 7

increased plasma glucose and glycosuria. needs to be dealt with urgently or may result in ketoacidosis

Question 8

what is ketoacidosis

Answer 8

increased beta oxidation of fats and low insulin;glycogen = lots of keno bodies e.g acetoacetate. H+ dissociates with ketones = ketoacidosis = hyperventilation, dehydration, nausea, abdominal pain and vomiting

Question 9

causes of type 2 diabetes

Answer 9

older and overweight

genetic predisposition and evidence that immune system is involved

Question 10

symptoms of type2

Answer 10

same triad of symptoms as type 1 + 
low energy 
presistnent infection (thrush) 
infections of feet 
slow healing 
visual problems 
NO ketoacidosis because still producing insulin

Question 11

diagnosing type 2

Answer 11

random blood glucose of > 11.1 mmol
fasting of >7mmol
glucose>11.1mmol 2 hours after 75g on anhydrous glucose OGTT (oral glucose tolerence test)
must do these other have important legal and medical implications

Question 12

management of type 1

Answer 12

treated using insulin injections. educated to do at right time and right dose. often needs to be increased after infection or trauma.
dietary control and regular exercise plus always need to be measuring blood glucose with finger prick- risk that its low and need to be aware of these symptoms

Question 13

management of type 2

Answer 13

diet or oral hypoglycaemic drugs e.g
sulphonylureas- increases insulin secretion and reduces insulin resistance
metformin - reduces gluconeogensis
dietry management and regular exercise are also v important and must do this too

Question 14

consequence of persistent hyperglycaemia

Answer 14

associated with abnormal metabolism of glucose to products that may be harmful to cells. uptake into nerves, eye and kidney because these cells don’t need insulin to take up glucose. this leads to v high levels of glucose in these tissues and its metabolised using NADPH. a product of it is also sorbitol

Question 15

whats so bad about the use of NADPH

Answer 15

reduction of this resource leads to increased disulphide bond production = changed structure and function of these proteins

Question 16

whats about one of the products being sorbitol

Answer 16

causes osmotic damage to cells

Question 17

what is glycation

Answer 17

another consequence of hyperglycaemia. it disturbs the function of proteins by glucose binding the AA.

Question 18

what is glycated HB

Answer 18

glucose in blood reacts with valine in Hb = glycated Hb. in healthy person this ranges form 4-6% but in diabetics =10% glycated. this must be measured over a 3 month period as this is the life span of an RBC

Question 19

macrovascular complications of diabetes

Answer 19

increased risk of stroke
risk of MI
poor circulation to periphery - especially feet

Question 20

microvascular complications of diabetes

Answer 20

diabetic eye disease - osmotic effect of glucose = visual problems or even caters. diabetic retinopathy- damaged blood vessels in retina leads to blindnesss because they leak, form exudates, rupture because they are new weak vessels.
diabetic kidney disease- damage to glomeluri, poor blood supply and damage from infections e.g UTI (seen by protein in urine)
diabetic neuropathy - loss of sensation due to alternation in function of ANS
diabetic feet- poor blood supply, damaged nerves and increased risk of infection - gangrene common
alll this is made worse if the blood glucose is poorly controlled

Question 21

what is metabolic syndrome

Answer 21

a cluster of dangerous risk factors associated with cardiovascular disease; diabetes, raised plasma glucose, abdominal obesity, high cholesterol and BP

Question 22

causes of metabolic syndrome

Answer 22

insulin resistance 
central obesity 
genetics 
physical inactivity 
ageing

Question 23

how to tell if someone has metabolic syndrome

Answer 23

>94 (men) >80 (women) cm waist 
raised triglycerides 
raised blood glucose 
reduced HDL 
do I need to know numbers?