diabetes

Question 1

What is a metabolic disorder?

Answer 1

Abnormal chemical reactions disrupting the body’s metabolism. Metabolism is the chemical processes that occur within a living organism to maintain life. E.g catabolism, anabolism.

Question 2

What are some statistics about diabetes?

Answer 2

• 1/10 people live with diabetes in the world
• number of people living with diabetes will increase by 250 million by 2045
• diabetes impacts over 319,000 people in Scotland
  (World Health Organization, 2023)

Question 3

What are the different types of diabetes?
(Herrington, 2019)

Answer 3

Type 1 diabetes:
- Average age of onset is before 30
- Rapid rate of onset
- 10% of all diabetics
- Caused by an insulin deficiency resulting from destruction of beta cells in pancreas
- May be caused by autoimmune disease but contributing factors are uncertain
- Treated by daily insulin injections
Type 2 diabetes:
* Average age of onset usually after 40
* Gradual rate of onset
* 90% of all diabetics
* Caused by a loss of insulin receptors on target cells, leading to insulin resistance
* Contributing factors include excess body weight and inactive lifestyle, more prevalent in certain ethnicities
* Treated through lifestyle changes hopefully controlling disease, if not oral diabetic medication or insulin injections may be used.
Gestational diabetes:
- About 1 in 50 women develop diabetes during pregnancy.
- Usually disappears after the woman gives birth

Question 4

What are the functions of the pancreas?

Answer 4

Exocrine- cells secrete digestive enzymes into ducts in small intestine
Endocrine- pancreatic islets contain alpha, beta, and delta cells.
Alpha cells- secrete glucagon which stimulates liver cells to convert glycogen into glucose and fatty acids and amino acids into glucose when blood glucose levels fall. This glucose is then released into the bloodstream, causing blood glucose to rise.
Beta cells- secrete hormone insulin which stimulates cells to absorb glucose and amino acids from the blood causing blood glucose to fall.
Delta cells- secrete somatostatin, a hormone that works with the pancreas to regulate other endocrine cells, e.g. inhibiting the release of glucagon and insulin.
(Marshall, 2017)

Question 5

Describe the regulation of blood glucose

Answer 5

the bloodstream
* high BG levels stimulate beta cells to secrete insulin
* insulin triggers the liver to take up more glucose and store it as glycogen. This results in BG levels returning to normal
* when BG drops below a certain point, alpha cells in the pancreas release glucagon into the blood
* Glucagon stimulates the liver to break down stored glycogen into glucose, which is then released into the bloodstream, raising BG.
(Marshall, 2017)

Question 6

List some symptoms of hyperglycaemia:

Answer 6

• extreme fatigue
• frequent urination
• sudden, unexplained weight loss
• slow healing wounds
• always hungry
• blurry vision
• always thirsty
• numb or tingling feet
• diabetic ketoacidosis
• lowered B-cell function
  (Diabetes UK, 2022)

Question 7

How is diabetes diagnosed?

Answer 7

1. Haemoglobin A 1c value >6.5%
2. Fasting venous plasma >7 moll/L
3. Symptoms of hyperglycaemia and a casual (random), plasma glucose >200 mg/dl or 11.1 mmol/L
   Prediabetes- a haemoglobin A 1c value of 5.7-6.4%
   Non diabeteic patients have a blood sugar level less than 7.8mmol/L .
   (Diabetes UK, 2022)

Question 8

How is diabetes treated?

Answer 8

Oral hypoglycaemic agents for T2:
- some stimulate B cell production of insulin
- decrease hepatic glucose production, decreases intestinal absorption of glucose, increases insulin sensitivity
- reduce insulin resistance and increases sensitivity
Insulin Therapy
there are long, medium, short, and rapid acting insulins, or mixes.
(NHS, 2024)

Question 9

Describe the different insulin types.

Answer 9

Rapid- take at start of a meal, takes 3-5 hours
short- take 25 mins before a mean, lasts 5-8 hours, taken alongside basal insluin
intermediate- basal, take one or twice per day
long-acting- basal, taken once per day at the same time
(NHS, 2024)

Question 10

What factors affect insulin dosage?

Answer 10

• carbohydrate intake
• physical activity
• illness
• body mass
• insulin resistance
  (NHS, 2024)

Question 11

What should be done in the case of hyperglycaemia?

Answer 11

The recommended BG target for diabetes patients is 6-10 mmol/L (4-12 is also acceptable). some patients will have lower BG target e.g. pregnant women

Check BG levels, ideally review BG pattern over last 48 hours. If BG is elevated over 8mmol/L it’s hyperglycaemia.

Adjust insulin dose prior to elevated BG. Increase by 10% of insulin dose is recommended.

Check ketone levels in T1 diabetics and all patients during illness.

Observe pattern of pre-meal BG levels therafter and adjust dose again is necessary.
(NHS, 2024)

Question 12

How is diabetes managed long term?

Answer 12

• Closed loop insulin delivery system: links a secondary device called a continuous glucose monitor (CGM sensor) which automatically adjusts some of the insulin delivered based on continually monitored blood sugar levels.
  -iLET bionic pancreas: made of an insulin pump and software that decides how much insulin to deliver based on person’s individual requirements
• lab grown B cells to produce insulin (still under research)
  (NHS, 2024)

Question 13

List some non-pharmacological management techniques for T2

Answer 13

• education for healthy living advice
• daily physical activity
• smoking cessation
• weight reduction
• dietary changes- low carb diet has been shown to have positive outcomes after a year, reduction in HbA1c and weight loss, resulting in less medication
• reduced alcohol consuption
  (World Health Organization, 2023)

Question 14

What is diabetic ketoacidosis (DKA)?

Answer 14

Occurs when a lack of insulin cayses ketones, a chemical produced in the liver during fat breakdown, to build up in the blood.
This can be very harmful and life threatening and needs urgent treatment.
(Centers for Disease Control and Prevention, 2022)

Question 15

List some symptoms of DKA.

Answer 15

• feeling thirsty
• needing to pee more often
• stomach pain, feeling sick or being sick
• diarrhoea
• breathing more deeply than usual
• breath that smells fruity (like pear drop sweets or nail polish remover)
• feeling tired, sleepy or confused
• blurred vision
  (Centers for Disease Control and Prevention, 2022)

Question 16

Describe DKA treatment

Answer 16

Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood through IV fluids.
Replacing electrolytes (minerals in your body that help your nerves, muscles, heart, and brain work the way they should). Too little insulin can lower your electrolyte levels through IV fluids
Receiving insulin. Insulin reverses the conditions that cause DKA.
Taking medicines for any underlying illness that caused DKA, such as antibiotics for an infection.
Ensure regular BM and ketone checks, hourly, Obs
(Centers for Disease Control and Prevention, 2022)

Question 17

What causes DKA?

Answer 17

Very high blood sugar and low insulin levels lead to DKA. The two most common causes are:
Illness. When you get sick, you may not be able to eat or drink as much as usual, which can make blood sugar levels hard to manage.
Missing insulin injections, or the wrong insulin dose.
Other causes include:
Heart attack or stroke.
Physical injury
Alcohol or drug use.
Certain medicines
(Centers for Disease Control and Prevention, 2022)

Question 18

List some symptoms of hypoglycaemia

Answer 18

• confusion
• loss of consciousness
• dizziness
• shaky
• fatigued
• rapid and shallow breathing
• emotionally liabale
• BM reading les sthan 4.0 mmol/L
  (Diabetes UK, 2022)
  –

Question 19

How is hypoglycaemia treated?

Answer 19

• give 15-20g carbohydrates e.g. glucose tablets, sugary drinks,
• stop insulin administration
  (NHS, 2024)

Question 20

How does diabetes impact other areas of health?

Answer 20

• glaucoma
• cataracts
• stroke
• heart attack
• nephropathy- kidney disease
• peripehral neuropathy- decreased or increased sensation
• peripheral artery disease
  (Herrington, 2019).

Question 21

Name some policy measures to reduce the burden of diabetes.

Answer 21

• marketing bans
• front of pack nutrition labels
• taxes on sugar sweetend beverages and subsidies on fruit and veg
• product reformations, loweing unhealthy ingredients in food e.g. sugar, salt, saturated and trans fat
  (Public Health England, 2018)

NHS Diabetes Prevention Programme (NHS DPP)
- resulted in 7% reduction in the number of new diagnoses of Type 2 diabetes in England between 2018 and 2019, with around 18,000 people saving the dangerous consequences of the condition (NHS England, 2023).

Question 22

How is nurtrition therapy used in the management of diabetes?
(Abu-Quamar, 2019).

Answer 22

• tailored dietary plans can be developed, considering individual’s needs
• things like BP, glycaemic status, lipid profile, associated morbidities, and personal preference should be considered
• dietary plans should include a range of options

Question 23

How can diabetes effect adolescents?
(Corbet, 2020).

Answer 23

● Accepting and adapting to a diagnosis of type 1 diabetes may be more challenging in adolescence than at other times in people’s lives, because this is a crucial developmental period
● Many patients find managing type 1 diabetes complicated and demanding, and it can affect their daily lives and social activities significantly
● A diagnosis of type 1 diabetes can have several psychological effects on adolescents. For example, it may compound self-esteem and body image issues