DM

Question 1

Q1. What are the types of DM ? Talk about pathogenesis of each.

Answer 1

* Type 1 diabetes (T1DM): is characterized by an absolute deficiency of insulin secretion caused by pancreatic beta cell destruction, usually resulting from an autoimmune attack. Type 1 diabetes accounts for approximately 10% of all cases.
* Type 2 diabetes (T2DM): is caused by a combination of peripheral resistance to insulin action and an inadequate compensatory response of insulin secretion by the pancreatic beta cells (relative insulin deficiency. Approximately 80% to 90% of patients have type 2 diabetes

Question 2

Q2. What’re the functions of insulin?

Answer 2

The principal metabolic function of insulin is to increase the rate of glucose transport into certain cells in the body
Carbohydrates:
* Increases the uptake of glucose into various tissues
* Stimulates glycogenesis in many tissues, but especially the liver
* Stimulates hepatic generation of glucose-6-phosphate from glucose
Proteins:
* Enhances the uptake of amino acids into peripheral tissues
* Stimulates protein synthesis –for this reason, insulin can be regarded as one of the growth hormones
Fats:
* Stimulates lipid uptake into cells
* Enhances oxidation of lipids once inside cells
* Also causes fat deposition by stimulating lipogenesis in adipocytes and in the liver

Question 3

Q3. Mention other hormones affect blood glucose level. How do they act?

Answer 3

(all of them increase blood glucose level)
* Glucagon
* Catacholamines: epinephrine and norepinephrine
* Glucocorticoids: most important being cortisol
* Somatotrophin: a pituitary hormone

Question 4

Q4. Precautions of DM patient going for surgery? How to prevent intra-op hypoglycaemia?

Answer 4

• Patients with diabetes must be prioritized in the operating list
• Routine overnight admission is not necessary
• Starvation time should be no more than one missed meal
• Analgesia and anti-emetics should be used to enable early return to diet and usual insulin regime
• Insulin infusions should only be used if a patient is expected to miss more than one meal
• 0.45% sodium chloride with 5% glucose and 0.15% or 0.3% KCl is the recommended IV fluid
• Capillary blood glucose should be measure hourly during and after the any surgical procedure
• The WHO surgical safety checklist should identify all diabetic patients
• The target blood glucose should be 6-10 mmol/ L (acceptable range 4-12 mmol/ L).

Question 5

Q5. What are the suspected post-op complications in this case?

Answer 5

Immediate:
* Hyper or hypoglycemia
* Dehydration with electrolytes imbalances
* Hyperglycemic hyperosmolar syndrome
* DKA
Late:
* Infection
* Sepsis
* Impaired wound healing

Question 6

Q6. What labs should be done to prevent the immediate complications?

Answer 6

RBS – ABG – K levels

Question 7

Q7. Post-op who will be involved in care of this patient?

Answer 7

In hospital – Diabetes nurse and may contact Endocrinologist
outpatient – the GP and family doctor.