Diabetes

• The pancreas and Type 1 diabetes are related.
• Blood glucose provides energy and is a ubiquitous energy source.
• Glycogen is stored glucose.
• The Central Nervous System (CNS) cannot substitute glucose; delivery is critical as the brain is dependent on supply.
• Hypoglycaemia is defined as blood glucose levels below 3mmol/L.
• Hyperglycaemia is defined as blood glucose levels above 10mmol/L.
• Diabetes mellitus is characterized by persistent hyperglycaemia.
• Inappropriate loss of glucose leads to osmotic diuresis, which can be fatal.
• Increased thirst and urine production due to diabetes can lead to dehydration, unconsciousness and death.
• Polysaccharides and disaccharides must be digested into monosaccharides before absorption.
• Different carbs are broken down by different enzymes.
• Glucose is generated by the digestion of starch.
• Sodium-dependent hexose transporter (SGLUT-1) carries glucose and galactose into the enterocytes.
• Glucose taken orally is more effective at stimulating insulin release because it stimulates the release of incretin hormone in the gut than if administered IV.
• Glucose is less effective at stimulating insulin release in diabetic patients.
• Short duration insulins include actarapid, Humulin S, with onset between 30 - 45mins, peak between 2 - 4 hours, and duration between 5 - 8hours.
• Long acting insulins include Levemir and lantus, with duration between 12 - 18hours and 18 - 24 hours respectively.
• Abasaglar is a basal insulin for once daily use and is bioequivalent to insulin glargine (Lantus), 100 units/ml in cartridges or as a pre-filled pen.
• Intermediate acting insulins include insulatard, Humulin I, with onset between 2 - 4h, peak between 4 - 6h, and duration between 8 - 14hours.
• Tresiba (Degludec) 200units/1ml is available in a pre filled pen device, with the dose counter showing the number of units irrespective of strength.
• Newer insulins include Tresiba (Dugludec) 100units/1ml, a long acting analogue, available in 3ml cartridges or pre filled pen device.
• Rapid acting insulins include apidra, Humalog, novorapid, with onset between 5 - 15mins and duration of 4hrs.
• Premixed insulin preparations are generally used twice daily.
• Biphasic insulin preparations are a mixture of intermediate and short duration.
• Insulin types include rapid acting, short acting, intermediate acting, long acting, premixed, and formulations such as rapid and short acting.
• Homeostasis of hyperglycaemia involves food intake/ endogenous glucose production (liver) and insulin release (pancreatic β-cells).
• Homeostasis of hypoglycaemia involves fasting, glucagon release (pancreatic α-cells), and endogenous glucose production (liver, muscle, adipocytes).
• Incretins are hormones in the GIT that stimulate insulin production.
• Glucose-dependent insulinotropic polypeptide (GIP) achieves its insulinotropic effects by binding to its specific receptor (GIPR), which is positively coupled to increases in intracellular cAMP and Ca2+ levels in β cells.
• Random levels of 5.6 - 11.1 mmol/l may indicate pre-diabetic state of reduced glucose tolerance, which needs a glucose tolerance test.
• Diabetic retinopathy, caused by small blood vessel damage to retina, leads to progressive loss of vision and possible blindness.
• Amino acids and lipids are converted into glucose by a process known as gluconeogenesis during the effects of glucagon.
• Diagnosis of Type 1 diabetes is done based on symptoms, serum glucose level, and fasting glucose level.
• Glucagon binds to the receptors on its target cells, activating the adenyl cyclase, stimulating the production of cAMP, which is the eventual trigger for the reactions.
• Diabetes mellitus is usually caused by autoimmune destruction of the insulin-producing b-cells.
• Type 1 diabetes is mainly childhood onset and is an irreversible autoimmune disease.
• Environmental factors can trigger the development of autoimmunity to the pancreatic beta cells.
• Sibling of a person with type 1 diabetes has a 6-7% risk of developing it themselves.
• More fatty acids are used in respiration during the effects of glucagon.
• Parenteral insulin is used in 99% of people with type 1 diabetes.