L14 - Diabetes Flashcards
Apart from CV disease what other long term diseases are diabetics at risk of?
- blindness (retinophathy)
- kidney disease (nephropathy)
- Neuropathy
- Diabetic foot
- amputation
- vascular disease
- heart attack
- intermittent claudication
- erectile dysfunction
What are the typical SYMPTOMS of someone with currenlty untreated type 1 diabetes
polydipsia, polyphagia, polyuria, weight loss, blurring of vision, recurrent urogenital infections e.g. thrush, general malaise
Clinically what are the criteria for diabetes?
1 abnormal test and symptoms or 2 abnormal tests
Tests are - Fasting glucose/non-fasting glucose/HbA1c
Describe the management for a type 2 diabetic
weight loss, Lifestyle changes such as stopping smoking, exercise, low fat (specifically cholesterol diet), education, non-insulin medication such as metformin (gluconeogenesis inhibitor). Eventually insulin if required.
What are the signs and symptoms of a DKA
Kussmaul breathing (Deep and laboured breathing), abdominal pain, nausea, vomiting, confusion and other symtpoms of untreated diabetes. Signs are hyperkalaemia, a high anion gap and elevated ketones
What is the treatment for a DKA?
fluids, insulin and electrolytes
A type 2 diabetic presents as confused with extreme thirst. What complication could they possibly be undergoing
hyperosmolar non-ketotic syndrome
What are some long term complications of untreated or poorly controlled diabetes
Kidney damage, blindness, foot ulcers, amputations, loss of sensation in fingers and toes, stroke, heart attack, excess sweating/passing gas.
What is metabolic syndrome?
A clutser of the most dangerous risk factors associated with CV disease - diabetes, raised resting plasma glucose, abdominal obesity, high cholesterol and hypertension
how many disulfide bonds are there in insulin?
3
what is the half life of insulin?
5 minutes
Which transporter allows glucose into pancreatic beta cells so the plasma glucose can be measured?
GLUT2 (this is also in the liver wheres GLUT4 is expressed on skeletal muscle and adipose tissue in repsonse to insulin
What effect would an increase in ATP intracellular concentration have on a Beta cell?
would cause the closure of the ATP sensitive potassium channel -> depolarisation -> calcium moves in -> increase in release of insulin
NOTE - the ATP increase has come from the increased metabolism activity of glucose thus showing that there is an elevated amount of glucose in the plasma -> insulin needs to be released to signal cells to take it up
what would you expect to happen to the concentration of C peptide in a diabetic who has just injected insulin?
remains the same - synthetic insulin is made without C peptide
why can insulin only be injected and not taken orally?
insulin is a peptide hormone, if digested orally it would be broken down into its constituent amino acids thus rendering it inactive
What is diabetic foot and how does it arise?
ulcers developing on foot because of a mixture of poor blood supply due to microvasculature damage and neuropathy
what does aetiology mean?
The underlying cause of the disease
What metabolism specific effects do glucagon and insulin have?
glucagon - stimulates glycogenolysis (lipogenesis and ketogenesis too) and gluconeogenesis in the liver
insulin - glycogenesis and translocation of GLUT 4 channels in liver, adipose and skeletal muscle
Briefly explain the aetiology of type 1 diabetes
Autoimmune response where self tolerance to pancreatic beta cells is lost -> they are broken down by the body -> insulin can’t be produced -> glucose accumulates in the plasma
Briefly explain the aetiology of type 2 diabetes
The body makes insulin but the glucose transporters are not sufficiently translocated in response to it i.e. the body’s cells develop an ‘insulin resistance’ - they don’t respond correctly to it.
what are the risk factors for type 2 diabetes?
obesity/lack of exercise/hypertension/genetic factors
explain why DKA doesn’t happen in type 2 diabetes generally
There is still circuating insulin -> the glucagon:insulin ratio isn’t sufficient to cause lipolysis
What is hyperosmolar non-ketotic syndrome
Water moves into plasma because of it’s high osmolarity -> increased urination and massive dehydration -> can lead to mental status changes
What are some tests and questions you would do on someone you believe is a newly presenting diabetic?
SQITARS
urine dip test to look at glucose and ketones
FBC
headaches?/weak?/thirsty or hungry?/frequency of urination?/fruity breath?
