General Diabetes Revision

Question 1

How many people in the UK have diabetes?

Answer 1

2.8 million in the UK.
Equates to around 6.2% of the population.
75% of these people have Type 2 Diabetes.
It is estimated that a further 1 million people have diabetes but have not yet been diagnosed with it.

(Diabetes UK, 2010)

Question 2

What is HBA1c?

Answer 2

The best single management of blood glucose levels.

A red blood cell count for the average amount of blood glucose over about 90 days.

This is measured as glucose sticks to the haemoglobin to make the molecule “glycosylated haemoglobin”. The more glucose in the blood, the more “glycosylated haemoglobin” will be present in the blood.

Assesses the risk of any complications.

Question 3

What are the therapeutic ranges for HBA1c? (%)

Answer 3

4-6 is excellent.
7-8 is good.
9 or above is poor.

Question 4

What are the therapeutic ranges of mmol/L and mg/dL?

Answer 4

2.6-6.3mmol/L is excellent.
This is equivalent to 50-115mg/dL (HBA1c)

8. 2-10.0mmol/L is good. This is equivalent to 150-180mg/dL (HBA1c)
9. 9mmol/L or higher is poor. This is equivalent to 215mg/dL (HBA1c)

Question 5

What happens to the body when a person has Diabetes Mellitus?

Answer 5

Glucose is carried to the cells of the body organs by the red blood cells.
The diabetic pancreas has little or no insulin, or the cells don’t respond to the insulin that is produced, so the glucose is not absorbed.
The glucose accumulates in the blood, so the healthy glucose range can’t be maintained by the body.
Due to this, the liver produces more glucose, but the body can’t absorb this either.
When this happens, fat and protein are broken down to produce glucose, but this doesn’t work so no energy is produced.
The diabetic patient feels tired and loses weight.
The unused glucose is passed into the urine - the patient becomes thirsty and more urine is produced.
Without glucose, the cells in the body are starved of energy and this can lead to them being unable to carry out their vital functions.
If this is left untreated, every organ of the body is affected.

Question 6

What happens when the body has the following:

High Blood Glucose

Normal Blood Glucose

Low Blood Glucose

Answer 6

When the body has raised blood glucose, insulin is released by beta cells.

Normal blood glucose levels are when the liver releases glucose into the blood.

When the body has low blood glucose, glycogen is released by the alpha cells of the pancreas.

Question 7

What is Diabetes Mellitus?

Answer 7

Diabetes Mellitus is a condition in which the amount of glucose in the blood is too high because the body can’t use it properly.
This is due to no insulin/not enough insulin being produced.

Question 8

What happens with the normal process of producing insulin of a person that does not have diabetes?

Answer 8

Glucose is carried to the cells through the red blood cells.

This is absorbed with the help of insulin.

The healthy pancreas produced insulin independently, and moves the glucose into the cells of other organs.

Question 9

Where does fat store on the body of a person with diabetes?

Answer 9

Around the abdomen.

Question 10

What is claudication?

Answer 10

Pain in the calf from short distance walking.

This is due to not enough glucose going into the muscles.

Question 11

How is diabetes diagnosed?

Answer 11

Venous plasma glucose blood test that is sent to the laboratory.

Symptoms and other tests are also indicators. These include glycosuria, random finger pricks or symptoms alone.

Fasting glucose is usually above 7.0mmol/Ltwo hours post glucose load, more than 11.1mmol/L

Question 12

How is type 2 diabetes treated?

Answer 12

Diet alone.

Diet and exercise.

Oral medication.

Oral medication plus insulin.

(Diabetes Care Pathway)

Question 13

How is artificial insulin made?

Answer 13

It is grown by genetically modified yeast.

Question 14

What does high blood pressure indicate the risk of?

Answer 14

Greater risk of having a stroke.

Question 15

Why are people with mental illness more susceptible to diabetes?

Answer 15

Lifestyle choices:

Many are exercise deprived due to their lifestyle of spending lots of time indoors.

They are less likely to go to their GP if they are concerned about their physical health - this makes them more prone to physical health problems as they go untreated.

People with schizophrenia have altered fat lipid metabolism which makes them more likely to develop type 2 diabetes.

Question 16

Which population is mostly affected by diabetes globally?

Answer 16

South Asia - ethnic minorities diagnosed with diabetes is 6x greater.

Question 17

Which cells produce insulin?

Answer 17

Islets of Langerhans.

Question 18

What happens when blood sugars are high? (Above 15mmol/L)

Answer 18

Unused glucose is turned into urine which becomes very saturated. This causes extreme thirst.

The body therefore becomes starved of glucose, so the person becomes tired.

Question 19

What happens when the blood sugars are low?

Answer 19

Glucogen is released by the alpha cells of the pancreas.

This makes the liver release glucose into the blood which raises the blood glucose levels to normal range.

Question 20

What happens when blood glucose is high?

Answer 20

Insulin is released by beta cells of the pancreas.

Question 21

What percentage of diabetic men experience erectile dysfunction?

Answer 21

Research suggests that 50% of diabetics get erectile dysfunction.

10% of men above the age of 40 will suffer from erectile dysfunction regardless of if they are diabetic or not.

This can affect a mans confidence and can cause a decline in their sexual activity.

Question 22

Is poor concentration and fatigue linked to Diabetes?

Answer 22

Due to fluctuating blood sugar levels a diabetic patient can have intermittent episodes of sleep apnoea.

This can be the reason that a diabetic person has poor concentration and fatigue.

Question 23

Does diabetes affect a persons mood?

Answer 23

It is common for a person with diabetes to experience fluctuations in mood, especially due to the fluctuation of blood sugars.

It is also common for men and women to feel anxiety, anger, remorse and guilt as an effect of their condition, especially with type 2 diabetes if it is adult onset - as this could have been prevented by earlier lifestyle changes. It is feelings like these that can dampen the persons spirits and cause them to feel apprehensive and depressed.

Question 24

What are the risk factors of someone developing type 2 diabetes?

Answer 24

Family history.

Previous gestational diabetes.

Obesity.

Metabolic syndrome.

Hypertension.

Gout.

Ischaemic heart disease.

Cerebrovascular disease.

Peripheral vascular disease.

Some drugs such as steroids, or high dose thiazides.

Question 25

What are nice guidelines for blood glucose lowering in type 2 diabetes?

Answer 25

Discuss the persons HBA1c target level which may be higher than the recommended 6.5%.

Encourage maintaining this target unless there are side effects that are impairing the quality of life.

Discuss how lowering HBA1c can benefit future health.

Monitor for 2-6 months dependant on the individuals needs, until it is stable.

Monitor 6-monthly until blood glucose levels are stable.

Implementing this guidance is the responsibility of the care provider, and keeping practice up to date.

Question 26

What is diabetes insipidus?

Answer 26

It is a condition in which the kidneys are unable to conserve water, often because there is insufficient anti diuretic hormone, or the kidneys are unable to respond to the anti diuretic hormone.

Diabetes insipidus does not involve hyperglycaemia.

Question 27

What is diabetic ketoacidosis?

Answer 27

A condition where the body breaks down fat for energy and ketones spill into the urine.

If untreated, this may result in coma or death.

Question 28

What is diabetic hypersmolar syndrome?

Answer 28

This occurs when blood sugar is excessively high and available insulin is ineffective.

In this case, the body cannot use glucose or fat for energy, and glucose is excreted into the urine.

If untreated, this may result in coma or death.

Question 29

What can a person with diabetes control in their diet to reduce the chances of developing complications associated with diabetes?

Answer 29

Controlling their blood glucose levels.

Keeping blood pressure under control.

Controlling their blood lipid levels.

Question 30

What happens when unused glucose enters the urine?

Answer 30

It becomes saturated causing UTI and extreme thirst.

Question 31

What is gestational diabetes?

Answer 31

When a lady is pregnant and hypertension affects the bodies ability to carry glucose

Question 32

What would be the concern if a patient developed microalbuminurea?

Answer 32

They may have an onset of diabetic nephropathy