Tutorial 3 Flashcards
Q: A 23-year old journalist presents with a 2-month history of weight loss. She drinks up to 3.5 litres (water, tea, lemonade) a day and passes a similar volume of urine, and wakes up at night three times to pass urine. There are no abnormal physical signs. Her urine has very high concentrations of glucose and ketones. Capillary blood glucose was 23 mmol/L.
What is the diagnosis?
A: diabetes mellitus T1 (high ketone)
T2 won’t get high ketone as in T2 there is enough insulin to prevent high ketone levels
Q: A 23-year old journalist presents with a 2-month history of weight loss. She drinks up to 3.5 litres (water, tea, lemonade) a day and passes a similar volume of urine, and wakes up at night three times to pass urine. There are no abnormal physical signs. Her urine has very high concentrations of glucose and ketones. Capillary blood glucose was 23 mmol/L.
Why does she have glucose in her urine and why is she passing so much urine?
A: she has no insulin
body can’t use all of the glucose so it goes to kidneys= but there’s so much= beyond renal threshold
kidneys are unable to retain glucose= goes into urine
-and by osmotic diuresis, water is dragged out of blood into urine too
Q: What surrogate marker for insulin can we measure? Describe (3).
A: C peptide measurement is a good indicator of beta cell intrinsic function
C peptide last 30 minutes while insulin lasts 4
C peptide doesn’t undergo first pass metabolism= not broken down by liver
Q: A 58 year old bus driver presents with angina pectoris due to coronary artery disease. He is overweight (Body Mass Index, BMI = 32 kg/m2). During investigation he is found to have a fasting plasma glucose of 12 mmol/L (normal range < 6.0 mmol/l). He is started on a diet for his diabetes.
What is the diagnosis and why? (3)
A: diabetes mellitus type 2
older
has no ketosis
obese
Q: A 58 year old bus driver presents with angina pectoris due to coronary artery disease. He is overweight (Body Mass Index, BMI = 32 kg/m2). During investigation he is found to have a fasting plasma glucose of 12 mmol/L (normal range < 6.0 mmol/l). He is started on a diet for his diabetes.
What are important features of his diet? (2)
A: healthy normal diet
with aim to lose weight- especially central weight (tummy) = reduces insulin resistance
Q: A 58 year old bus driver presents with angina pectoris due to coronary artery disease. He is overweight (Body Mass Index, BMI = 32 kg/m2). During investigation he is found to have a fasting plasma glucose of 12 mmol/L (normal range < 6.0 mmol/l). He is started on a diet for his diabetes.
What other steps would you take to reduce his risk of cardiovascular disease? (4)
A: -reduce salt intake (helps with bp in case it’s high)
- no smoking
- exercise to lose weight
- check cholesterol and manage intake
