Explanation of T2DM Flashcards
How would you explain the normal anatomy and physiology of diabetes?
“After we eat a meal, the food is broken down into sugar, which is released into our blood. This sugar is the fuel for all the cells that make up our body, and needs to get from the blood into the cells for them to function properly.”
Explain to the patient that they should think of sugar like a car, insulin like a key and the cells in their body as a garage.
“When you drive home, you use your key, the garage opens and you can park your car. This is what normally happens in our body too. If we imagine sugar is the car, the cells are the garage, and a hormone called insulin is the key, sugar can only enter the cells when insulin is working properly.”
How would you explain what diabetes is?
“In diabetes, the sugar cannot get into the cell as the insulin is not working properly. If we think of it in terms of a car not being able to get into the garage – this would cause congestion on the roads. This also happens with sugar – it cannot get into the cells and therefore builds up in the tubes of the body which supply the cell with blood. This build-up of sugar in the blood can cause damage to the cells if it remains too high for too long – whether that be the cells of the heart, eyes, liver, kidneys etc.”
How would you explain the cause of diabetes?
Type 1 diabetes involves a combination of genetic and environmental factors (e.g. viral infections as an initial trigger for the disease) that ultimately results in the patient’s immune system destroying their insulin-producing cells in the pancreas. As a result, they are no longer able to produce insulin and are therefore reliant on insulin injections for the rest of their life.
Type 2 diabetes also involves a combination of genetic and environmental factors (e.g. diet, obesity and overall lifestyle). People with type 2 diabetes have a combination of inadequate insulin production and increased insulin resistance (the cells ignore the insulin and don’t allow the sugar in).
How would you explain the problems or complications of diabetes?
Outlining potential complications of diabetes is necessary so that the patients can identify problems early and seek medical advice. Being aware of common problems will encourage patients to adhere to their treatment and remain vigilant.
Link the build-up of sugar in the blood back to the complications of diabetes. For example, high levels of sugar in the blood can damage the blood vessels of:
1. the kidneys causing kidney failure
2. the heart which can increase the risk of heart attacks
3. the brain which can increase the risk of stroke
4. the eyes causing loss of vision
5. the nerves of the lower limbs causing peripheral neuropathy
Also, outline how diabetes can cause slow healing of wounds and explain the risk of diabetic ulcers (including what these look like).
Give a leaflet about diabetes and foot care
How would you explain the management of diabetes?
Start by explaining what the patient can do to manage their condition. Including:
- Lifestyle change: healthy diet (avoiding foods high in sugar), losing weight, regular exercise
- Stop smoking (if relevant)
- Emphasise the importance of tight glycemic control
- Attending diabetic checks
- Encourage good foot care and regular podiatrist appointments
Then explain how you as the doctor will be managing their condition. Important points include:
- Regular check-ups to screen for diabetic complications
- Regular blood tests to check blood sugar levels
- Counselling on starting metformin (this helps the garage recognise the key i.e. increases insulin sensitivity) or other oral hypoglycaemics
- Managing any complications as they arise
