S7 Diabetes

Question 1

What is diabetes?

Answer 1

When blood glucose is too high (hyperglycaemia) and over years leads to damage of small and large blood vessels causing premature death from cardiovascular diseases

Question 2

What are the two types of diabetes?

Answer 2

Type 1 and type 2

Question 3

What causes the diabetes epidemic?

Answer 3

Environment (e.g. obesity) not genetics

Question 4

Why does blood glucose rise?

Answer 4

• inability to produce insulin due to beta cell failure

* insulin production adequate but insulin resistance prevents insulin working effectively (linked to obesity)

Question 5

How does type 1 diabetes mellitus arise?

Answer 5

Autoantibodies are directed against beta cells and insulin producing cells are destroyed

Mostly due to genetics - alleles of HLA-DQB1 or MHC-II

Question 6

How does type 2 diabetes mellitus arise?

Answer 6

The pancreas may not produce enough insulin (relative insulin deficiency) or the cells don’t use insulin properly (insulin resistance)

Question 7

What are the symptoms of diabetes mellitus?

Answer 7

• polyuria (hyperglycaemia)
• polydipsia (hyperglycaemia)
• weight loss (inadequate energy utilisation)
  (+ blurry vision, thrush, tiredness, weakness, lethargy)

Severity depends on levels of blood glucose

Question 8

How do you diagnose diabetes?

Answer 8

Lab confirmation

• fasting glucose
• oral glucose tolerance test
• HbA1c

Need symptoms and 1 abnormal test or asymptomatic and 2 abnormal tests

Question 9

What are the symptoms of type 1 diabetes?

Answer 9

• rapid onset weight loss
• polyuria
• polydipsia
• vomiting due to ketoacidosis (late)

Question 10

Who is the typical type 1 diabetes patient? What are there bloods like?

Answer 10

• usually under 30 years
• elevated venous plasma glucose
• presence of ketones

Question 11

How is type 1 diabetes treated?

Answer 11

Subcutaneous injections of exogenous insulin several times a day

Question 12

The production of what is suppressed by insulin? How is this used in diagnosis of type 1 diabetes?

Answer 12

Production of ketones

If ketones are present in blood, it indicates immediate insulin therapy is needed as implies insulin absent

Question 13

How does ketoacidosis occur? How do you treat it?

Answer 13

Hyperglycaemia —> ketoanameia —> acidosis
Enhanced lipolysis leads to uncontrolled ketosis

Hospitilisation, IV fluids and insulin

Question 14

How is type 2 diabetes often managed?

Answer 14

Managed with controlling diet, tablets (metformin - reduces amount of glucose released by the liver and helps insulin work better) and weight loss, patient education, monitor chronic complications

Question 15

Who gets type 2 diabetes mostly?

Answer 15

People over 40 years who are overweight/obese, however an increase in younger people/children with it

Question 16

What causes insulin resistance to develop?

Answer 16

Obesity 
* muscle and liver fat deposition 
* elevated circulating free fatty acids 
Physical inactivity 
Genetic influences

Question 17

What are the symptoms of type 2 diabetes?

Answer 17

Variable as there is a slower rise in blood glucose levels - could be asymptomatic

• possibly polyuria, polydipsia and weight loss
• no urinary ketones

Question 18

What are the acute complications of diabetes?

Answer 18

• diabetic ketoacidosis in type 1
• hyperosomolar non-ketotic syndrome in type 2
• hypoglycaemia as a result of treatment (iatrogenic) - coma

Question 19

What are the chronic complications of diabetes?

Answer 19

• macrovascular - cerebrovascular, cardiovascular, peripheral vascular diseases e.g. stroke, heart attack, claudication, gangrene
• microvascular - retinopathy, nephropathy, neuropathy e.g. blindness, renal replacement therapy, diarrhoea, painful peripheral neuropathy, constipation, foot ulceration

Question 20

What is metabolic syndrome? How much of population of UK could have it?

Answer 20

Group of most dangerous risk factors associated with cardiovascular disease - diabetes, raised fasting plasma glucose, abdominal obesity, high cholesterol and BP

About 60%

Question 21

How can someone have metabolic syndrome?

Answer 21

* if their waist is more than 94cm for men or more than 80cm for women 
Plus any 2 of the following:
* high TAG
* low HDL 
* high BP
* high fasting blood glucose

Question 22

What causes metabolic syndrome?

Answer 22

• insulin resistance
• central obesity
• genetics
• physical inactivity
• ageing