Endocrine 1 - diabetes

Question 1

type 1 vs type 2

Answer 1

Type 1 - body des not produce insulin (immune cells attaking)
type 2 - not enough insulin made or unresponsive to insulin

Question 2

symptoms of diabetes

Answer 2

polyurea
polydipsia
recurrent infections

Question 3

distinguishing diagnosis of diabetes

Answer 3

• random plasma glucose of 11.1mmol/l
• fasting plasma glucose more than 7mmol/l
• HbA1c> 48mmol/mol
• no symptoms – OGTT (75 g glucose), fasting > 7 or 2h value >11.1 mmol/l

Question 4

weight fluctuations of type 1 and type 2

Answer 4

weight loss in 1

weight gain in 2

Question 5

presenting features of diabetes

Answer 5

thirst
polyuria
weight loss/gain and fatigue
hunger
blurred vision
pruritus and balanitis

Question 6

definition of type 1

Answer 6

absolute deficiency of insulin due to an autoimmune process of attacking beta cells in the pancreas (islets of langerhans)

Question 7

features of type 1

Answer 7

weight loss
urinary ketones
lethargy 
smell of acetone
abdonomal pain

Question 8

how can you get hypoglycaemia when on treatment for diabetes

Answer 8

mismatch of the insulin peak and peak of glucose when eating

subcutaneous injection is slow to spread

Question 9

microvascular complications if untreated

Answer 9

nephropathy

• can develop proliferative retinopathy and severe neuropathy
• kidney artitecture changes, granular, smaller, lose protien

Question 10

treatment of type 1

Answer 10

insulin treatment
2x daily medium acting insulin
basal bolus therapy (includes pre quick meal acting insulin)

Question 11

how to measure blood glucose control and number of low diabetes

Answer 11

haemoglobin A1C
blood sugar is attached to RBC
can measure amount og sugar glycated to th eRVC
higher the number higher complications
(low diabetes is 48)

Question 12

type 2 diabetes causes

Answer 12

obesity

lack of physical exercise

Question 13

why does being overeweight etc lead to type 2

Answer 13

pancreas has to work harder to remove sugars in blood stream

excess weight leads to insulin resistnce

Question 14

pathogenesis of type 2

Answer 14

CV risk
increased thrombogenesis
early hyperinsulinemia
abnormal lipids
hypertension
central obesity 
insulin resistance
hyperglycaemia

Question 15

complications of tyep 2

Answer 15

too much sugar sticking to the vessels (steroids can stick to vessels)
- can lead to MI, stroke, peripheral vascular disease

Question 16

treatment of type 2

Answer 16

weight loss

exercise

Question 17

medical treatment of type 2

Answer 17

diet
metformin
sulphonylurea
insulin

Question 18

what does metformin do

Answer 18

reduces blood glucose by improving glucose intake (sensitivity of insulin action

Question 19

what does sulphonylurea

Answer 19

stimulates release of insulin from pancreatic beta cells

Question 20

emergency cases caused by diabetes

Answer 20

diabetic ketoacidosis
hyperosmolarity hyperglycaemic state
hypoglycaemia

Question 21

diabetic ketoacidosis

definition and causes

Answer 21

usually type 1
pancreas does not wok, ketone used as fuels
definition
hyperglycaemia more than 15mmol/l
ketons
venous bicarbonate less than 15mmol/l

causes - infections, commission of insulin

Question 22

hyperosmolarity hyperglycaemic state and definition

Answer 22

• body insulin insufficient to keep sugar levels stable so they rise, water intake increases and increases urea but the kidneys are not flushing out, kidneys start to fail
• blood becomes thick and gooey, become confused
• can lead to blood clots, cause pulmonary embolism in lungs

definite

• hyperglycaemia (blood glucose over 30mmol/l)
• hyperosmolarity (osmolarity over 320 mmol/l)
• accompanies by dehydration (hypovolaemia)

Question 23

symptoms of hypoglycaemai

Answer 23

sweating
tremor
palpitations
(caused by adrenalin)

Question 24

signs of hypoglycaemai

Answer 24

loss of concentration
drowsiness
anger/sadness

Question 25

monitoring diabetes

Answer 25

venous blood glucose
H A1C
capillary blood glucose
blood ketones
urinary ketone