Diabetes mellitus

• What is diabetes mellitus

  Persistent hyperglycaemia
• What is the normal glucose range

  4 - 6 mmol/l
• What are the types of diabetes

  Type 1

  Type 2

  Gestational
• What is the pathology of type 1 diabetes

  Autoimmune destruction of pancreatic beta cells results in absolute insulin defficiency.
• What is the pathology of type 2 diabetes

  Insulin resistance in tissues often caused by lifestyle. There is often a strong family trait associated with it.
• What is gestational diabbetes

  A temporary condition in pregnancy
• Which type of diabetes is most common

  Type 2
• What is the inheritance for maturity onset diabetes of the young [MODY]

  Dominant
• What gender has a higher rate of Type 2 diabetes

  Males
• What form of diabetes is most common in children

  Type 1
• What is MODY

  Maturity onset diabetes of the young.

  It is the onset of diabetes in people under 25 who are of normal weight but cannot produce insulin.
• Why is MODY different to type 2 diabetes

  It is genetically passed to children and appears when the person is under 25 and of normal weight.
• Why is MODY different to type 1

  There is no autoimmune destruction of pancreatic Beta cells.
• What causes hypoglycaemia

  Hyperinsulinism and glycogen storage disease
• How does the body work to combat hyperglycaemia

  1. Insulin is released from pancreatic beta cells
  2. Glucose is converted to glycogen in the liver
  3. Glucose is taken up by cells
• How does the body respond to hypoglycaemia

  1. Glucogen is released from pancreatic alpha cells
  2. Glycogen is converted to glucose by the liver
• Label the changes that occur throughout the day

  X.

  A) Glucose

  B) Insulin

  C) Glycogen produced

  D) Glucagon

  E) Glucose produced

  F) Insulin

  G) Glycogen produced

  H) Glucose

  
• Describe insulin release

  1. Glucose enters the Beta cell
  2. Phosphorylation of glucose via glycolysis produces a pyruvate
  3. ADP is phosphorylated
  4. Potassium channels close [Intracellular Potassium increases]
  5. Membrane becomes depolarised
  6. Calcium channels open [Intracellular calcium increases]
  7. Exocytosis of the insulin granule
• Describe insulin action

  1. Insulin binds to the receptor
  2. Tyrosine kinase is activated
  3. Signal transduction
  4. GLUT4 transporters are translocated to the membrane
  5. Influx of glucose [Decreases plasma glucose]

  Glucose can be metabolised by glycolysis or lipogenesis.

  GLucose may be stored as glycogen via glycogenesis.
• How is Type 1 treated

  Insulin administration or pancreas transplant.
• How is Type 2 treated

  Reduction in calories.

  Sulphonyleureas causes Beta cells to secrete more insulin.

  Laparoscopic adjustable gastric band
• What type of surgery is LAGB

  It is laparoscopic adjustable gastric band.

  It's characterised as weight loss surgery often termed bariatric.
• What are the main diagnostic procedures for Diabetes

  Urine glucose test.

  HbA1c.

  Blood glucose.
• What are the blood glucose measurements that can be taken

  Fasting [FBG]

  Random [RBG]

  Oral glucose tolerance [OGTT]
• What is the FBG blood glucose

  Taken when you have not eater for 8 hours
• What is the normal range for FBG

  4.5 - 5.2
• What is an FBG > 7 mean

  Diabetes
• What does an FBG 6 - 6.9 mean

  Impaired fasting glycaemia
• What is the normal range for RBG

  < 8
• What does an RBG > 11.1 mean

  Diabetes
• What follow up test is done after RBG

  A fasting blood glucose
• Describe the oral glucose tolerance test

  1. Determine the baseline FBG
  2. 75 g of oral glucose in 300 ml of water taken in 5 minutes
  3. Measure plasma glucose over 2 hours
• What happens to glucose normally after an OGTT test

  It should increase and then decrease to FBG after 2 hours
• What happens to a diabetic during the OGTT test

  Glucose levels continue to increase to > 11 mmol/l.
• What happens to a a person with impaired glucose tolerance during the OGTT test

  Glucose levels continue to increase to 7.8 - 11 mmol/l.
• What is HbA1c

  Glycated haemoglobin
• What happens to HbA1c as glucose rises

  It increases to above 5%
• What is the half life for RBCs

  60 days.
• What levels of HbA1c are seen in diabetics

  High levels
• What are the consequences of high HbA1c

  Neuropathy and retinopathy.