DM an introduction

Question 1

what are the presenting features of diabetes

Answer 1

polyuria and polydipsia (thirst)
weight loss and fatigue 
puritis vulvae and balanitis
hunger 
blurred vision

Question 2

describe the difference in characteristics of diabetes

Answer 2

check photos

Question 3

what are the 4 classifications of diabetes

Answer 3

latent autoimmune diabetes in adults (LADA) type 1
maturity onset DM of he young (MODY) type 2
gestational diabetes
secondary - paretic destruction, acromegaly, cushings

Question 4

what 3 clinical features are a sign of type 1 diabetes and must be treated with immediate insulin

Answer 4

weight loss
moderate or large urinary ketones (read at 15 seconds)
high urinary glucose (read at 30 seconds)

Question 5

what are the aims of treatment of diabetes

Answer 5

relief of symptoms
prevention of ketoacidosis
prevention of complications both micro/macrovascular

Question 6

what are the microvascular complications of DM

Answer 6

retinopathy (regular eye testing)
neuropathy (regular foot examination)
nephropathy (urine test for micro albumin and blood test for kidney functions - U and E)

Question 7

why is it important to avoid nephropathy

Answer 7

poor prognosis
CV mortality creating increases
end stage renal failure
tend to develop retinopathy and neuropathy as well

Question 8

what is the aim during treatment of type 1 diabetes and what do you use

Answer 8

restore physiology of the beta cell
insulin treatment - twice daily short/medium acting insulin - basal bolus
judge CHO intake
awareness of exercise affect on blood glucose

Question 9

what is hypoglycaemia caused by in type 1 diabetes

Answer 9

high insulin levels

Question 10

how many people with type 1 diabetes experience hypoglycaemia coma

Answer 10

30%

Question 11

what are the symptoms and signs of hypoglycaemia

Answer 11

autonomic - nausea, tremor, sweating, tachycardia, anxiety

neuroglycopenic - confusion, drowsiness, lethargy, slurred speech

Question 12

what is dilemma of type 1 diabetes in terms of glucose targets

Answer 12

setting higher glucose targets reduce risk of hypo but increase risks of diabetic complications
setting lower targets reduce risk of complication but increase risk of hypoglycaemia

Question 13

why do some people not track blood glucose

Answer 13

risk of hypoglycaemia 
too difficult 
risk of weight gain 
interfere with life stye 
lack of knowledge

Question 14

what are the main risk factors of type 2 DM

Answer 14

obesity and lack of physical exercise

Question 15

what happens to the liver and muscle/adipose tissue in type 2 DM

Answer 15

liver has increased hepatic glucose production

M and AT - decrease insulin dependant glucose uptake by adipose tissue and muscle

Question 16

what are the two main physiological characteristic behind type 2 DM

Answer 16

B cell dysfunction and insulin resistance

Question 17

what are the complications of type 2 diabetes

Answer 17

blindness
increase in CV mortality and stroke
lower extremity amputations
end stage renal failure

Question 18

what are the macrovascular complications of type 2 DM

Answer 18

MI, stroke, peripheral vascular disease

Question 19

what is the life expectancy shortened by in type 2 DM

Answer 19

about 10 years

Question 20

what is the treatment of type 2 diabetes

Answer 20

weight loss and exercise

medication to control BP, blood glucose and lipids

Question 21

what are some of the complications of type 2 diabetes which we need to prevent

Answer 21

hypertension 
overweight 
hyperlipidaemia 
hyperglycaemia 
thrombosis potential 
nephropathy

Question 22

describe the mode of action of thiazolidinediones (resiglitazone/Pioglitazone)

Answer 22

decrease insulin resistance in adipose tissue, skeletal muscle and liver
beneficial effect on B cell function
agonists at nucelar receptor peroxisome proliferator activated receptor gama (PPAAR-y)

Question 23

describe the mode of action of biguanides (such as metformin)

Answer 23

suppresses hepatic glucose output and enhance glucose sensitivity and stimulate insulin mediated glucose disposal

they do not stimulate insulin secretion

Question 24

describe the mode of action of sulphonylureas and meglitininides
such as glicalzide and glimepiride

Answer 24

both blower fasting blood glucose concentrations by stimulating insulin secretion from the pancreas

Question 25

describe the mode of action of alpha-glucosidase inhibitors such as acarbose

Answer 25

delay digestion and absorption of carbs in the GIT - inhibit this enzyme responsible for metabolism of complex carbs into absorbable monosaccharides

Question 26

describe the mode of action of glucagon like peptide 1 GLP analogues

Answer 26

mimic GLP1 a GIT hormone that increases insulin secretion from the pancreas and inhibits glucagon release

Question 27

describe the mode of action of dipeptidyl peptidase 4 DPP-4 inhibitors

Answer 27

block DPP4 which would otherwise inactive GLP

Question 28

what are the clinical consequences of hypoglyceamia

Answer 28

cardiac arrthmyias and neurological implications which lead to brain damage
inflammation, increased risk of thrombosis and endothelial cell dysfunction which leads to vascular death