Diabetes complications

Question 1

Outline what metabolic syndrome is

Answer 1

Clustering of risk factors for CVD

• visceral adiposity/central obesity
• Impaired glucose metabolism
• Dyslipidaemia: increased triglycerides, decreased HDL-cholesterol
• Hypertension
• visceral/central obesity and insulin resistance are central in pathogenesis of metabolic syndrome

Question 2

What are the aims of therapy eg insulin therapy in diabetes?

Answer 2

1. ) remove symptoms of uncontrolled diabetes
   - improve glycaemic control
2. )Reduce risk of complications of diabetes
   - Multiple risk factor modification: Glycaemic control,BP,Lipids, lifestyle
3. ) Prevent disability ( related to diabetes or its treatment); acute-chronic complications
4. ) Early detection of complications
   - screening

Question 3

Outline the microvascular complications of diabetes

Answer 3

• Diabetic retinopathy(&cataracts, glaucoma)
• Diabetic neuropathy(& sensory impairment i.e peripheral neuropathy)
• Diabetic nephropathy
• Limb amputation

Question 4

Outline the macrovascular complications of diabetes

Answer 4

• CHD
• stroke
• congestive heart failure (&atherosclerosis & poor blood supply to lower limbs-peripheral vascular disease)

Question 5

Outline the non-vascular complications of diabetes

Answer 5

• Cancer
• Infections(bacterial & fungal infections of the skin)
• Degenerative diseases
• Depression
• Congenitive disorders
• sexual dysfunction
• gangrene
• Ulceration
• Necrobiosis lipidoica (rare granulomatous skin disorder which can affect the shin of T1DM pts)

Question 6

How can the lifestyle of a diabetic pt be modified to prevent diabetes emergencies

Answer 6

1. ) Diet: normal healthy diet
   - avoid ‘diabetic foods’
   - portion size
2. ) Weight control
3. ) exercise
4. )stop smoking

Question 7

How do we decide which treatment to use for glycaemic control

Answer 7

• Evidence of effectiveness (surrogate/hard endpoints)
• Other effects (eg weight/hypoglycaemia)
• Other considerations: route of administration,co-morbidities

Question 8

Outline the different mechanisms of actions for gylcaemic control treatments

Answer 8

• Insulin sensitivity
• Insulin secretion
• Slow glucose absorption

Question 9

How can we cause weight gain in a diabetic pt

Answer 9

• Incretin therapies

- Increase glucose excretion

Question 10

What are incretins

Answer 10

A group of metabolic hormones that stimulate a decrease in blood glucose level
-They are released after eating & augment the secretion of insulin released from the pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism

Question 11

Explain the idea of ‘glycaemic legacy’ in T2DM

Answer 11

• If you generate a ‘bad glycaemic legacy’ it drives your risk of complications
• Idea of metabolic memory
• Better prognosis with early glycaemic control in the course of the disease

Question 12

Outline the multiple defects that contribute to the progression of T2DM

Answer 12

The following all lead to hyperglycaemia:

• Decreased incretin effect
• Increased lipolysis
• Increased glucose reabsorption
• Decreased glucose uptake from skeletal muscles
• Neurotransmitter dysfunction
• Increased hepatic glucose production
• Increased glucagon secretion from alpha cells of the pancreas
• Decreased insulin secretion from the pancreas

Question 13

Outline the neurogenic symptoms of hypoglycaemia

Answer 13

1. ) Adrenergic:
   - palpitations
   - tremor
   - anxiety/arousal
2. )Cholinergic
   - sweating
   - hunger
   - paresthaesia

Question 14

Outline the neyroglycopenic symptoms of hypoglycaemia

Answer 14

• Cognitive impairments
• Behavioural changes
• Psychomotor abnormalities
• Seizure
• Coma

Question 15

Outline the complications & effects of severe hypoglycaemia

Answer 15

1. ) Increased risk of cardiac arrhythmia
   - Abnormal prolonged cardiac repolarisation; increased QTc and QTd
   - Sudden death
2. ) Progressive neuroglycopenia
   - cognitive impairement
   - Unusual behaviour
   - Seizure
   - Coma
   - Brain death

Question 16

What is bariatric surgery

Answer 16

• Weight related therapy
• Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery)

Question 17

What is Orlistat

Answer 17

• A weight related therapy
• Works by blocking enzymes in your gut which digest fat.
• Nearly a third of the fat that you eat is blocked
• The undigested fat isn’t absorbed into your body and is passed out with your faeces

Question 18

What modifiable risk factors exists

Answer 18

• BP
• Lipids
• Smoking
• Physical inactivity
• Diet

Question 19

State the 9 annual care processes for all people with diabetes age 12 and over

Answer 19

1. )HbA1c- blood test for glucose control
2. ) BP- measurement for CVD risk
3. ) Serum cholesterol- blood test for CVD risk
4. )Serum creatinine- Blood test for kidney function
5. ) Urine albumin/creatinine ratio- urine test for kidney function
6. ) Foot risk surveillance- foot examination for foot ulcer risk
7. ) BMI- measurement for CVD risk
8. ) Smoking history- question for CVD risk
9. ) Digital retinal screening-photographic eye test for eye risk