Lecture 14

Question 1

What is diabetes?

Answer 1

When blood glucose is too high (hyperglycaemia) and over years leads to damage of the small and large blood vessels causing premature death from cardiovascular diseases.

Question 2

What are the types of diabetes?

Answer 2

Type 1

Type 2

Question 3

Why is diabetes a major health concern?

Answer 3

• risk of amputation
• leading cause of blindness in working age
• 1/4 develop kidney disease
• life expectancy is reduced

Question 4

What is the largest epidemic in human history?

Answer 4

Type 2 diabetes- due to the environment, not genetics

Question 5

How is glucose obtained from food?

Answer 5

• after eating, your body breaks down food into glucose
• glucose is a sugar which is the body’s main source of energy
• as blood glucose rises, body sends signal to pancreas which releases insulin
• insulin binds to an insulin receptor, allowing glucose to pass through

Question 6

Why does blood glucose rise?

Answer 6

• inability to produce insulin due to beta cell failure

- insulin production is adequate but insulin resistance prevents insulin from working effectively= obesity

Question 7

What is type 1 diabetes caused by?

Answer 7

Autoimmune beta cell destruction

immune response to self antigens

Question 8

What does type 1 diabetes cause?

Answer 8

Pancreas does not secrete enough insulin

= ABSOLUTE INSULIN DEFICIENCY

Question 9

Why does type 2 diabetes develop?

Answer 9

-pancreas may not produce ENOUGH insulin
=RELATIVE INSULIN DEFICIENCY
-cells do not use insulin properly (insulin resistance: insulin can’t fully unlock cells to allow glucose to enter)

Question 10

How does diabetes mellitus (hyperglycaemia) present?

Answer 10

-polyuria (large production of urine)
-polydipsia (drinking lots of water)
-blurred vision
Due to inadequate energy utilisation (as energy is being excreted in the urine)
-tiredness
-weakeness
-weight loss

Question 11

How do you diagnose diabetes?

Answer 11

Labatory confirmation

• fasting glucose test
• oral glucose tolerance test (take a glucose drink and blood glucose levels is monitored at regular intervals after: if they have diabetes then the blood glucose will remain higher than should be)
• HbA1c (measurement of glucose attached to haemoglobin)

Symptomatic: 1 abnormal test
Asymptomatic: 2 abnormal tests

Question 12

What is the fasting glucose test?

Answer 12

Don’t eat/drink 8-10 hours before the test

• diabetic: 7 mmol or above
• normal: 5.5mmol or below

Question 13

What is a theory as to why incidence of type 2 diabetes is increasing?

Answer 13

We are not as exposed to pathogens, so immune system is more immature and finds it hard to differentiate between self anitgens and non-self antigens

Question 14

What are the symptoms of type 1 diabetes?

Answer 14

• rapid onset weightloss (weeks)
• polyuria/polydipsia
• late presentation: vomiting due to ketoacidosis

Question 15

What does the patient clinically present with in type 1 diabetes?

Answer 15

• elevated venous plasma glucose
• presence of ketones (breakdown products of fat)
• young <30 yo

Question 16

How do you treat type 1 diabetes?

Answer 16

Exogenous insulin

• subcutaneous injections several times a day
• can have a pump- continuous insulin infusion

Question 17

What does ketone production suggest?

Answer 17

Absence of insulin

-presence of ketones is an indication for immediate insulin therapy

Question 18

What supresses ketone production?

Answer 18

Insulin (in presence of starvation there may be some ketones in healthy people)

Question 19

What is ketoacidosis?

Answer 19

• deficiency of insulin
• enhanced lipolysis= uncontrolled ketosis
• large quantities of ketone bodies

Question 20

Why does type 2 diabetes develop?

Answer 20

Insulin resistance

• obesity
• genetic influences
• physical inactivity
• muscle and liver fat deposition

Question 21

How can you treat type 2 diabetes?

Answer 21

-very low calorie diets
-bariatric surgery
Fall in liver fat content return of normal sensitivity to insulin and decreases pancreatic fat normalising B cell function

Question 22

What are the symptoms of type 2 diabetes?

Answer 22

Variable due to slower rise in blood glucose

• may have polyuria, polydipsia, weight loss
• NO urinary ketones

Question 23

What age group is affected

Answer 23

Over 40 years

increasingly seen in younger people

Question 24

How do you treat type 2 diabetes?

Answer 24

Weight loss (lifestyle)

• can use insulin
• non-insulin therapies

Question 25

What should you look for in patients with type 2 diabetes?

Answer 25

- other vascular risk factors- BP, lipids, smoking, exercise, diet - surveillance for chronic complications

Question 26

Give some examples of non-insulin therapies:

Answer 26

- metformin - thiazolidinediones - sulphonylureas

Question 27

What are some acute complications of diabetes?

Answer 27

``` Hyperglycaemia -diabetic ketoacidosis in type 1 -hyperosmolar non-ketotic syndrome in type 2 Hypoeglycaemia -coma ```

Question 28

What some chronic complications of diabetes?

Answer 28

- macrovascular/large vessel disease - cerebrovascular, cardiovascular, peripheral vascular disease - stroke, heart attack, intermittent claudication, gangrene - microvascular/capillary disease - retinopathy > blindness - nephropathy > renal replacement therapy - neuropathy - erectile dysfunction - foot ulceration - diarrhoea/constipation

Question 29

What is the metabolic syndrome?

Answer 29

Cluster of the most dangerous risk factors associated with cardiovascular disease -diabetes -raised fasting plasma glucose -abdominal obesity -high cholesterol -high BP Confer a marked increase in cardiovascular risk

Question 30

What must a person clinically have to have the metabolic syndrome?

Answer 30

-waist measurement >94cm men, >80cm women Plus any 2 of these: -raised triglyceride >1.7mmol/l -reduced HDL cholesterol <1 men, <1.2mmol/l women -raised BP >135/85 -raised fasting blood glucose >5.6mmol/l