Lecture 2 - Introduction to disorders of the endocrine system - Diabetes 1 and 2

Question 1

Define the role of the pancreas

Answer 1

Sense levels of glucose in the bloodstream

Question 2

What does insulin decrease in plasma?

Answer 2

Glucose
Amino acids
FFAs
‘anabolic’

Question 3

What does glucagon increase in plasma?

Answer 3

Glucose, ketones, ‘catabolic’

Question 4

What does glucagon do?

Answer 4

Can mobilise glycogen to release glucose into the bloodstream and keep your blood glucose levels normal
Catabolic hormone
Breaks down storage molecules to release glucose and provide energy for the body

Question 5

Name the three types of diabetes mellitus

Answer 5

Type 1 diabetes
Type 2 diabetes
Gestational Diabetes

Question 6

Define type 1 diabetes

Answer 6

the body is unable to produce any insulin
appears in childhood and before the age of 40
sudden onset
autoimmune disease of the pancreatic beta islet cells

Question 7

What are the symptoms of type 1 diabetes?

Answer 7

Increased urination
Increased thirst
Weight loss
Fatigue
Nausea and vomiting
Coma

Question 8

What are the benefits of islet cell transplantation for type 1 diabetes?

Answer 8

live without insulin injections
Improved blood glucose control
more stable control

Question 9

What are the risks of islet cell transplantation for type 1 diabetes?

Answer 9

Transplantation surgery risk
Immunosuppressant drugs side effects - to prevent your body from rejecting the islet cells
Need 2-3 transplants to have enough mass to produce insulin effectively

Question 10

Define type 2 diabetes

Answer 10

The body can’t produce enough insulin or the body cannot respond to insulin = insulin resistance
More common in people >40

Question 11

Symptoms of type 2 diabetes

Answer 11

Increased urination
increased thirst
Increased appetite
Fatigue
Blurred vision
Slow healing infections
Impotence in men
Slower onset than type 1

Question 12

Risk factors for T2DM

Answer 12

Family history
Age
Ethnicity
Weight
Blood pressure
High Cholesterol lipids
Sedentary lifestyle
Gestational diabetes

Question 13

Define insulin

Answer 13

Anabolic hormone
Activates a reactor tyrosine kinase
Levels may be low, normal or high in insulin resistance
Cells are able to carry out a certain amount of glucose metabolism

Question 14

Consequences of insulin resistance

Answer 14

Associated with metabolic syndrome, PCOS
Inflammation of liver
Hypertension
Atherosclerosis and increased risk of CVD
Low HDL ‘good’ cholesterol
Increase in fat stores (abdominal)
Elevated triglycerides
Fatigue and changes in appetite
Increased thirst and increased urination
Elevated blood sugar
Hyperglycaemia
Excess weight, genetic factors, sedentary lifestyle

Question 15

Define pre eclampsia

Answer 15

high blood pressure in pregnancy

Question 16

Name the tests for diabetes

Answer 16

Glycosylated haemoglobin (HbA1c)
Fasting plasma glucose test (FPG)
Oral glucose tolerance test (OGTT)
Urine analysis

Question 17

Define glycosylated haemoglobin (HbA1c)

Answer 17

When glucose attaches to proteins they become glycated (glycosylated)
HbA1c is a test that measures glycated haemoglobin

Question 18

What levels of HbA1c suggests diabetes?

Answer 18

> 48mmol/mol type 2
between 42-48mmol/mol risk of developing diabetes

Question 19

Explain the fasting glucose test (FPG)

Answer 19

Fast for 8hours blood sample taken
Blood sugar >7mmol/l in fasted state - diabetes

Question 20

Explain the oral glucose tolerance test (OGTT)

Answer 20

Fast for 8 hours, blood sample taken, drink sugary drink, 2hours later blood sample taken
Blood glucose 7.9-11 mmol/l - impaired glucose tolerance (IGT)
Blood glucose >11mmol/l - diabetes

Question 21

Explain the glycosuria urine analysis

Answer 21

Quick and simple ‘dipstick’ test
Less accurate than HbA1c or GTT
Kidney normally reabsorbs glucose into the body - excess glucose appears in urine

Question 22

Explain the ketone bodies urine analysis

Answer 22

Quick and simple ‘dipstick’ test
Body can switch from using glucose to using fats to provide cellular energy and produce ketones
Ketones can change blood pH leading to diabetic ketoacidosis particularly in type 1

Question 23

State the metabolic complications

Answer 23

Hypoglycaemia or hyperglycaemia
Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycaemic state (HSS) - associated with dehydration

Question 24

State the microvascular complications

Answer 24

Damage to small blood vessels - arterioles, capillaries and venues
Retina (retinopathy)
Kidney (nephropathy)
Nerves (neuropathy)

Question 25

State the macro-vascular complications

Answer 25

Damage to larger arteries
Brain - leading to stroke
Heart - leading to CHD
Legs and feet - leading to peripheral vascular disease

Question 26

Define diabetic microangiopathy

Answer 26

End up with fragile, leaky blood vessels - become smaller and smaller, blood flow disrupted

Question 27

Explain diabetic nephropathy

Answer 27

Damage to the capillaries in the glomerulus leads to breakdown of filtration barrier and more protein than normal collects in the urine
Exacerbated by hypertension
Develops slowly
Protein in urine - kidney dysfunction
BP increases so more proteins leaked from the blood vessels in kidney, kidney function can completely decline leading to chronic kidney failure

Question 28

Define neuropathy

Answer 28

Peripheral nerve dysfunction
Capillary damage - leads to nerve damage and loss of sensation
Begins loss of sensation in the toes and leads to injury
Increased risk of infection (ulcers, gangrene) - diabetic foot