Physiology

Question 1

What happens with glucose and insulin after eating (in a non diabetic)?

Answer 1

Glucose in blood rises and stimulates the pancreas to make more insulin.

Insulin rises which enables cellular uptake of the glucose. It also increases protein synthesis and inhibits breakdown of fat (lipolysis)

Excess glucose is stored as glycogen and fat.

Question 2

What happens with glucose and insulin in a fasting state (in a non diabetic)?

Answer 2

Blood glucose falls and insulin secretion decreases.

Glycogen is converted to glucose to maintain blood glucose.

Triglycerides are used for energy production, which releases free fatty acids and ketone bodies. Protein stores may also be used for energy production with prolonged fasting.

Question 3

What stresses the homeostatic glucose metabolism mechanism, and means that more insulin is needed?

Answer 3

When a person has increased visceral fat

Question 4

What is Type 1 Diabetes?

Answer 4

T1D is an autoimmune disease where little to no insulin is produced by the pancreas. Injected insulin is needed to enable cellular glucose uptake and prevent ketoacidosis. Most people with T1D have positive antibodies. You can inherit a predisposition for T1D, it is often diagnosed in childhood

Question 5

What is type 2 Diabetes?

Answer 5

Type 2 diabetes is a condition where people produce some insulin, but are insulin resistant. Metformin may be used to decrease insulin resistance, as well as diet and exercise interventions. Insulin may also be required. Type 2 diabetes is linked to obesity (visceral adiposity), inactivity and family history.

Question 6

What is inherited “monogenic” diabetes?

Answer 6

A rare condition when insulin is deficient due to a single gene mutation. It is characterised by young age of onset and can be misdiagnosed due to its presentation in slim adolescents.

Question 7

What is prediabetes (or impaired glucose tolerance)?

Answer 7

HbA1c 41-49 or borderline OGTT result.
Elevated glucose levels but not yet meeting diagnostic threshold of diabetes. Will likely go on to develop T2D, unless diet/lifestyles changes not made. Metformin may reduce risk of progression to T2D.

Question 8

What is GDM?

Answer 8

Pregnancy is accompanied by insulin resistance, caused by hormones released by the placenta. GDM develops in women whos pancreatic function is insufficient to overcome the insulin resistance.
Diabetes that is first diagnosed in pregnancy is GDM. GDM has a similar pathophysiology to T2D

Question 9

Risks of preconception T1/T2 diabetes?

Answer 9

Congenital abnormalities + miscarriage

Question 10

What are the risks of diabetes in pregnancy for the neonate? (8)

Answer 10

1. Hypoglycaemia (+ potential adverse affects on neurodevelopmental in later life)
2. Macrosomia
3. Shoulder dystocia/birth trauma
4. IUGR
5. RDS (surfactant synthesis affected)
6. Polycythaemia (can lead to jaundice + phototherapy)
7. Prematurity
8. Increased risk obesity and T2D in later life

Question 11

Who is in the multidisciplinary DiP team? (5)

Answer 11

1. Obstetricians
2. Physicians
3. Diabetes midwives
4. Dieticians
5. Social workers

Question 12

Role of the DiP team?

Answer 12

1. Nutritional education and lifestyle counselling
2. Individualised pregnancy and birth planning
3. Education around blood sugar testing
4. Prescribing treatment e.g metformin or insulin
5. Postpartum follow up

Question 13

Possible complications of diabetes for the woman

Answer 13

Hypertension, eye disease, heart disease, vasculopathies, renal impairment

Question 14

How can diabetes cause hypertension

Answer 14

Hyperglycaemia can cause damage to the blood vessels and kidneys, which can cause BP to rise

Question 15

Do people with hypertension have an increased risk of developing T2D?

Answer 15

Yes