PBL extra LOs

Question 1

what does the “tropin” suffix indicate

Answer 1

it acts upon another endocrine gland

Question 2

what are the driving regulations for group 1 (car) diabetics (4)

Answer 2

1. must inform the DVLA if taking insulin
2. If you have more than one severe hypo while awake (not driving) in 12 months you must stop driving and tell the DVLA -> licence will be revoked but can reapply in 3 months
3. If you have even one severe hypo while driving, you must stop driving and tell the DVLA straight away;
4. if severe hypo while asleep, NO need to inform DVLA

Question 3

what are the driving regulations for group 2 (HGVT) diabetics (2)

Answer 3

1. must inform DVLA if taking insulin
2. if severe hypo at anytime, even while sleeping, must inform DVLA -> licence could be revoked

Question 4

what are the 4 steps for if you have a hypo while driving

Answer 4

1. pull over safely;
2. switch off the engine;
3. take fast acting carbs;
4. don’t drive until 45 mins after your blood sugar levels are back to normal

Question 5

when should blood glucose levels be checked when driving (2)

Answer 5

1. must be checked 2hrs before driving
2. if driving for long journeys then they must be checked every 2 hrs

Question 6

what is the blood glucose level needed for driving

Answer 6

5.0mmol/L on finger prick - 5 to drive;
4.0mmol/L on flash glucose monitoring

Question 7

does the DVLA need to be informed if taking temporary insulin (<3months)

Answer 7

no- as long as healthcare team are being seen and advice is taken

Question 8

does the DVLA need to be informed if taking sulphonylureas

Answer 8

no - unless more than one severe hypos while awake have occurred in the last 12 months -> licence will be revoked

Question 9

does the DVLA need to be informed if taking diabetes medication other than (sulphonylureas)

Answer 9

no

Question 10

what organisms are commonly found in diabetic foot ulcers

Answer 10

S.aureus and Pseudomonas aeruginosa

Question 11

what is the Mgx for an unwell (flu/pneumonia etc.) diabetic pt with high blood glucose levels

Answer 11

2-6 units of short or rapid acting insulin subcutaneously -> glucose is likely high just due to glucose being released to aid the body in helping fighting off the infection -> so need to just control symtpoms

Question 12

DKA management

Answer 12

FIG PICK
F – Fluids – IV fluid resuscitation with normal saline (e.g., 1 litre in the first hour, followed by 1 litre every 2 hours)
I – Insulin – fixed rate insulin infusion (e.g., Actrapid at 0.1 units/kg/hour)
G – Glucose – closely monitor blood glucose and add a glucose infusion when it is less than 14 mmol/L
P – Potassium – add potassium to IV fluids and monitor closely (e.g., every hour initially)
I – Infection – treat underlying triggers such as infection
C – Chart fluid balance
K – Ketones – monitor blood ketones, pH and bicarbonate

Question 13

4 complications that could occur during DKA treatment

Answer 13

1. Hypoglycaemia (low blood sugar)
2. Hypokalaemia (low potassium)
3. Cerebral oedema, particularly in children
4. Pulmonary oedema secondary to fluid overload or acute respiratory distress syndrome

Question 14

biochem values for DKA resolution

Answer 14

pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

Question 15

what is the next step if the DKA resolution criteria has been met

Answer 15

if the pt is eating and drinking then switch to sub cut insulin

Question 16

3 areas of the body that insulin acts on

Answer 16

1. In muscle, insulin promotes the uptake of glucose from the bloodstream, facilitating its entry into cells, as well as helping make new proteins;
2. In adipose tissue, insulin promotes the uptake of glucose from the bloodstream, facilitating its entry into cells. This helps to lower blood glucose levels;
3. In the liver, insulin inhibits the production and release of glucose. It also promotes the storage of glucose in the form of glycogen;

Question 17

what molecule can be used to give an idea of insulin levels in the blood

Answer 17

c-peptide

Question 18

insulin pathway in the liver

Answer 18

1. glycogenesis: insulin binding to TRK receptors -> activation of PIK3/AKT -> these help to polymerise glucose into glycogen
2. glycolysis: glucose –(PIK3/AKT)–> ATP

Question 19

what is the only endogenous anabolic steroid

Answer 19

insulin (glucosepolymerised to glycogen)

Question 20

what kind of transporter is GLUT4

Answer 20

an insulin dependent glucose channel (becomes hyperactive in the presence of insulin)

Question 21

insulin in the muscles pathway

Answer 21

1. insulin binds to TRK receptors in muscle cells -> activates PIK3/AKT -> increased activity of GLUT4 receptors -> increased glucose into cells -> PIK3/AKT aid in ATP production from glucose
2. protesynthesis: increased amino acid uptake through stimulated amino acid channels -> increase protein synthesis;
3. glycogensis: glucose -> glycogen

Question 22

6 functions of insulin in the muscle

Answer 22

1. stimulates glucose uptake (GLUT 4)
2. stimulates glycogenesis
3. stimulates glycolysis (-> ATP release)
4. stimulates amino acid uptake and protein synthesis
5. inhibits glycogenolysis
6. inhibits proteolysis

Question 23

insulin action in the hypothalamus

Answer 23

stimulates satiety

Question 24

3 actions of insulin in adipose tissue

Answer 24

1. stimulates glucose uptake (GLUT4)
2. stimualtes lipogenesis
3. inhibits lipolysis

Question 25

what are the pre-pregnancy blood glucose targets in diabetic pts (3)

Answer 25

1. between 5 mmol/L and 7 mmol/L before breakfast ('fasting' level) 2. between 4 mmol/L and 7 mmol/L before meals at other times of the day 3. HbA1C should be <48mmol/mol

Question 26

what congential problems can occur in babies w diabetic mothers (4)

Answer 26

spina bifida, microcephaly, anencephaly, congenital heart disease

Question 27

5 obstetric complications w diabetes

Answer 27

1. foetal macrosomia (very big babies); 2. shoulder dystocia; 3. preeclampsia; 4. still birth; 5. increased likelihood of caesarean and polyhydramnios

Question 28

what diabetic emergency can pregnancy increase the risk of

Answer 28

DKA

Question 29

when does testing for gestational diabetes normally occur

Answer 29

between 24-28wks of pregnancy (6-7 months)

Question 30

what is the Somogyi phenomenon

Answer 30

low blood sugar (hypoglycemia) episode overnight leads to high blood sugar (hyperglycemia) in the morning due to a surge of hormones

Question 31

what is the dawn phenomenon

Answer 31

hyperglycaemia due to increased production of hormones in the morning