PBL 3 Flashcards
what is Humalog
also called insulin lispro – this is a fast acting inuslin that starts to work about 15 minutes after injection, used to manage blood sugar spikes and might help keep sugar levels in balance, most common side effect of Humalog is hypoglycaemia that can lead to levels of unconsciousness and passing out, should be taken 15 minutes before eating or right after a meal, with type I diabetes Humalog it needs to be used with a longer acting insulin, can also be used in type II
what is glargine insulin
– subcutaneous injection – this is a long acting insulin used in both type I and type II, side effects include oedema, and hypoglycaemia
what is a dipstick urine test
this is a urine test that checks pathological differences in the persons urine, checks can include for protein, glucose, blood, bilirubin, white blood cells, acidity
what is the anion gap
this is the contribution of the unmeasured anions to metabolic acidosis
what is the causes of type I diabetes
- Lack of insulin production, don’t produce any insulin therefore cannot control blood glucose levels
- Can be due to an autoimmune condition where the cells attack the pancreas and the beta cells are therefore cannot produce insulin
- Characterised by immune T cell mediated disruption of the pancreatic beta cells within the islet of Langerhans
- Usually develops by early adulthood
what are the signs and symptoms of type I diabetes
- Feeling thirsty
- Frequent urination particularly at night – billy has this
- Feeling tired
- Losing weight without trying
- Thrush that keeps coming back
- Blurred vision
- Cuts and grazes that are not healing
how do you diagnose type I diabetes
- Dipstick urine test – this can check to see if there is any glucose in the blood
Blood tests –
One abnormal plasma glucose
- (random ≥11.1 mmol/L or fasting ≥7 mmol/L) in the presence of symptoms (thirst, increased urination, recurrent infections, weight loss, drowsiness and coma)
Two fasting venous plasma glucose samples in the abnormal range
- (≥7 mmol/L) recommended in asymptomatic people
HbA1c
- Advantages – reliable measure stable and calculate the glucose over 3 months
- Disadvantages – high cost, Hb traits such as sickle cell influence it as well as conditions affecting the RBC turnover
- Has to be higer than 48 mmol/mol as recommended as the cut of point for diagnosing diabetes
how do you manage diabetes
Fast acting inuslin
- Humalog – patients should eat meal within 5-10 minutes
Long actin basal inuslin
- Glargine
- These are mcirocystals that release insulin slowly, they have a long duration of action of 18-26 horus with no peak
- Trys to mimic insulin secretion of a healthy individual
what are the treatments of hypoglycaemia
Eat or drink something sugary - 3 dextrose or glucose sweets - 5 small sweets likely jelly babies - 1 glass of non diet surgary drink - 1 glass of fruit jucie Emergency - Glucagon injection – this releases glucose from the liver
describe how type I diabetes can effect the social aspect
- Driving
- Alcohol intake
- Managing on their own
what are the causes of DKA
- Caused by if the body starts to run out of insulin
- Lack of inulin – causes carbohydrate unavailability (no glucose enters the cell) therefore minimics starvation state produces ketones
- High levels of glucagon – high levels because alpha cells are not inhibited by beta cells and readily release glucagon this contributes to the starved state
describe the mechanisms of hyperglycaemia
- Lack of insulin – this inhibits glycolysis, stimulates glycolysis and gluconeogenesis
- Excess glucagon – inhibits glycolysis – this is because it inhibits fructose -2,6-bispphoate- regulates phosphofructokinase -1, fructose -6-phosphate to fructose-2.6-bisphopshate which is the rate limiting step in glycolysis
what are the effects of hyperglycaemia
- Hyperosmolarity – causes osmotic diuresis – increased urine and loss of water and electrolytes in the urine
- Glucose in the urine – glucose is freely filtered by the glomerulus and reabsorbed, but when the threshold is reached it is filtered out into the glucose
- Dilutional hyponatremia – low sodium – there is a shift of water form the intracellular to the extracellular compartments due to imbalance of glucose
- Severe dehydration – due to vomiting and later decreasing fluid intake
describe the pathophysiology of DKA
- Arises due to lack of insulin and corresponding levels of glucagon rising
- This leads to an increased of glucose in the liver from glycogen via glycongenolysis and also through gluconeogenssi
- Absence of glucose leads to lipolysis in adipose tissue which are converted to ketones via beta oxidation
- Ketone bodies have a low pKa make the blood acidic
- Leads to metabolic acidosis
- Hyperventilation in order to compensate
- Excess glucagon turns off supply of substrate into the Krebs cycle and causes ketogenesis
- Ciritic acid is used up and there is a decrease of malonyl CoA in the liver, this turns off carnitine acyl transferase 1 and turns on ketogenesis as free fatty acids enter the liver – this is used for ketogenesis
what are the signs of DKA
- Needing to pee more than often
- Feeling thirsty
- Being sick
- Tummy pain
- Breath that smells fruity
- Deep or fast breathing
- Feeling very tired or sleepy
- Confusion
- Passing out