Type I Diabetes Management

Question 1

How does diabetes lead to glucose in the blood and muscle wasting?

Answer 1

lack of insulin = lack of cellular glucose uptake

Cellular starvation leads to proteolysis and muscle wasting. Excess circulating glucose leads to glucose in urine

Question 2

T/F Type I diabetes is an absolute lack of insulin

Answer 2

True, whereas type II is a relative deficiency

Question 3

Is type I diabetes a slowly progressing disease

Answer 3

Yes, because you need to lose quite a bit of beta cells to get symptoms

Question 4

What are some examples of long acting insulin? Which one is the most used?

Answer 4

isophane insulin
Glargine (Lantus), most used
Detemir

Question 5

Some short acting insulin drugs are modified. What’s the modification?

Answer 5

modified to make quicker action - how fast it is absorbed from subcutaneous deposition (not the cellular effect)

Question 6

What are some general structural modifications of insulin

Answer 6

adding or deleting amino acids

adding fatty acids (Detemir)

Question 7

What is a typical regime of insulin injection? (how is insulin administered)

Answer 7

one long acting insulin at bed time

one short acting insulin before each meal

Question 8

What is the advantage of using insulin pumps?

Answer 8

provides a background rate of insulin, so long acting insulin is not needed

Patient has control of insulin injected

Question 9

What is the advantage of artificial pancreas

Answer 9

Adds sensor of glucose, hence preventing hypoglycaemia at night

Question 10

What are the major issues with pancreas transplantation for diabetes

Answer 10

availability of tissue

life-long immunosuppression leading to increased risk of cancer

Question 11

Which three tissues are particularly endangered with hyperglycaemia

Answer 11

retina
kidney
nerves

Question 12

T/F diabetes is the most common cause of blindness and nephritis

Answer 12

True

Question 13

What are some complications of neuropathy from diabetes?

Answer 13

numbness of feet + amputation

autonomic neuropathy - problem controlling blood pressure

Question 14

Why is it important to measure blood glucose while being put on insulin?

Answer 14

so we can check the effectiveness of the dose given

Question 15

In what circumstance do we measure fructosamine for diabetes

Answer 15

When the patients have high red cell turnover and artificially low HbA1C

Question 16

Why do we check for urinary microalbumin

Answer 16

Check for renal function

Question 17

What are the symptoms of rapid glucose decline?

Answer 17

trigger SNS causing tachycardia, anxiety, tremor. Can also trigger silent angina due to racing heart rate

Question 18

What are the symptoms of absolute low glucose level?

Answer 18

brain malfunction, paralysis, coma, death

Question 19

T/F glucagon is the only factor influencing glucose liberation

Answer 19

False, there is some cross interaction with growth hormone and adrenoceptor blockers

Question 20

How does insulin affect K+ level?

Answer 20

Insulin helps to pump K+ into the cells. Low insulin will lead to hyperkalemia