select those that can apply to diabetes type 1
an absolute deficiency of insulin due to the destruction or degeneration of pancreatic beta cells
onset often occurs in childhood
requires daily insulin injections
they'll be fine if they alkalise. insulin is just a ploy from BIG PHARMA. and its probably caused by VACCINES!
Fasting glucose should be:
<5.6mmol/L
>7mmol/L
0mml/L (you should avoid glucose because cancer cannot survive if there is no glucose source!)
what blood glucose level would be suggestive of diabetes if taken as a fasting blood test?
I don't believe in pathology testing it's a scam by big pharma they just want you to get hooked on their drugs. wake up sheeple
how does glucose get into a body cell??
just goes straight through, no worries mate
*Insulin binds to its receptor (tyrosine kinase linked) causing it to self- phosphorylate. This starts many signalling cascades. * the final effect of these signalling cascades is translocation of the Glut-4 transporter to the plasma membrane, allowing influx of glucose into the cell
it asks nicely
it spent all it's birthday money on a fake I.D. so it could get in with it's friends who are older, but forgot it's star sign according to the I.D. card and had it taken away like, the second time it tried to use it. so, glucose can't get into the cells for another year.
what percentage of circulating glucose in 'typical' body functioning, should be reabsorbed form the kidneys back into the blood?
100% - it is all reabsorbed
90% - about 10% is excreted in the urine
50% - half goes back into circulation, the other half is excreted
select symptoms of hyperglycaemia
polydipsia (excessive thirst)
(polyuria) increased / more frequent urination
glycosuria (glucose in urine)
diuresis (increased production of urine)
blurred vision
lethargy and fatigue
dehydration
an insatiable urge to watch conspiracy documentaries such as vexed
sudden belief in "flat earth" theory
hyperglycaemia can be caused by low insulin levels. when glucose cannot be used by the body for energy, it has to use fat and protein. ketoacidosis is a dangerous condition that can occur as a result of this. what is ketoacidosis?
ketoacidosis is a pathological metabolic state, marked by uncontrolled ketosis. Free fatty acids are oxidised to ketones. They are b-hydroxybutyric acid, acetoacetic acid and acetone. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.
Ketoacidosis should be the goal of anyone trying to lose weight because it means you are burning fat and its super healthy and really good for you because all you have to do is eat some kale or drink some lemon juice and you can alkalise back to get your blood really alkaline and its so good for you.
so - do you remember the ketones that are produced in ketoacidosis? they were in RED in the lectures, so I assume we are meant to know them. Please select the correct ones!
b-hydroxybutyric acid
acetoacetic acid and acetone
c-hypoxibryani acid
acetone free nail polish remover and acetoacsthetic acid
just drink lemon in water!!!!!
do you remember the transporter that lets glucose into the cell once insulin has done its multi signalling thing?
glut-4 transporter
glut-c3.37 transporter
WE SHOULDN'T BE LETTING GLUCOSE INTO OUR CELLS! WAKE UP SHEEPLE!
Which condition do you think these symptoms are from? Symptoms (Autonomic): • Sweating • Tremor • Tingling lips • Hunger • Weakness • Tachycardia
Symptoms (neurological) • Confusion • Unsteadiness • Headache • Blurred vision • Slurred speech • Lack of concentration • Aggressive behaviour • Convulsions • Loss of consciousness
hypoglycaemia
hyperglycaemia
which condition do you think fits with the symptoms? Symptoms: • Polyuria • Lethargy • Polydipsia • Blurred vision • Dehydration Symptoms associated with Type I predominantly: • Weight loss • Ketone breath • Breathing changes • Nausea and vomiting • Abdominal pain
untreated, or insufficiently managed, hyperglycaemia can have long term complications. select those that apply.
macrovascular complications, such as heart disease, stroke, and peripheral vascular disease
microvascular disease such as retinopathy, neuropathy and nephropathy
an addiction to false eye lashes and lip fillers
angiogenesis is one of the primary reasons that vascular disease is a serious pathology related to diabetes. select the statements that are true of angiogenesis in diabetes.
in diabetes when insulin isn't working effectively, glucose cannot get into the tissues. the tissues interpret this lack of glucose as not enough vasculature, so they form new blood vessels
angiogenesis could be completed, known as 'proliferative' type pathology
angiogenesis could become locked at one of the early stages of angiogenesis, which can cause leakage from the vessels.
In order to make new blood vessels existing ones should be disassembled first. That is the stage at which leakage occurs (if it lasts too long)
In the eye, too many newly formed blood vessels could cover the retina. This can cause "diabetic blindness". Or, if existing vessels are locked into the initial steps of angiogenesis (destabilisation), leakage of plasma in the eye could cause the same outcome.
its good to have all those extra blood vessels. it will prevent neuropathy in the future.
classifications of diabetes
Type 1 Diabetes, Type 2 Diabetes, and, 'other' (primarily gestational diabetes)
the one thats just some extra sugar and then the one where you don't make enough of that thing. these are the technical names.
Which of the following describes Metformin?
Biguanide First line treatment for DMII Works by inhibiting gluconeogenesis, hence reducing release of glucose from the liver. Also reduces glucose absorption from GIT, and increases glucose uptake in fat tissue and muscle tissue. Take with meals or directly after. Start low dose and increase slowly. DOES NOT CUASE HYPOGLYCAEMIA WEIGHT NEUTRAL AEs GIT upsets, lactic acidosis (serious but rare – kidney issues increase risk) ********* • May initially cause GI distress Contraindicated: undergoing testing using IV dye, kidney problems. • Lactic acidosis
Usually only used when sulphynlurea dose maxed out. Works by reducing insulin resistance, especially in peripheral tissues. They increase sensitivity to insulin. They also reduce the amount of glucose released from the liver into the blood stream. Do so by working on PPAR gamma to affect metabolism of nutrients. Doesn’t matter if taken with food. Will NOT cause hypoglycaemia as monotherapy. IF DUAL THERAPY WITH INSULIN SECRETAGOGUES CAN CAUSE HYPOGLYCAEMIA OR WHEN TAKEN WITH SULPHNYLUREA AND METFORMIN ******** Heartfailure – do not use Liver disease – do not use
Provides instant burst of glucose goodness so the brain can function
which of the following best describes gliclazide?
Sulphnylurea It works by increasing the amount of insulin produced and released by beta cells of the pancreas. They do so by blocking the exit of potassium from the beta cell at the ATP sensitive potassium channel. Excess potassium in the cell leads to the depolarisation of the membrane. There is a subsequent influx of calcium. The raised intracellular calcium causes the emptying of insulin granules and the release of insulin. Needs residual function in beta cells to be effective Take just before a meal. CAN CAUSE HYPOGLYCAEMIA LINKED WITH WEIGHT GAIN AEs Hypoglycaemia ******** Weight gain, hypoglycemia
Incretin Mimetic Acts like GLP-1, activating GLP-1 receptor, releasing hormone from the GIT to pancreas, ordering the release of insulin when glucose levels in blood are high. Will only work in the presence of glucose, so no risk of hypoglycaemia. It also reduces the amount of glucose released from the liver and slows gastric emptying. Delayed gastric emptying can also help decrease appetite and prolong feeling of fullness. Given by subcut injection. CAN CAUSE HYPOGLYCAEMIA IF TAKEN WITH SULPHONYLUREAS AEs N&V Do not use in patients with kidney problems ********* Given by injection Severe kidney problems – do not use
which best describes rosiglitazone?
Thiazolidinediones Usually only used when sulphynlurea dose maxed out. It works by reducing insulin resistance, especially in peripheral tissues. They increase sensitivity to insulin. They also reduce the amount of glucose released from the liver into the blood stream. Do so by working on PPAR gamma to affect metabolism of nutrients. Doesn’t matter if taken with food. Will NOT cause hypoglycaemia as monotherapy. IF DUAL THERAPY WITH INSULIN SECRETAGOGUES CAN CAUSE HYPOGLYCAEMIA OR WHEN TAKEN WITH SULPHNYLUREA AND METFORMIN ******** Heartfailure – do not use Liver disease – do not use
Alpha-glucosidase inhibitor. Works on the surface of the small intestine to slow absorption of glucose into the blood by preventing the breakdown of carbohydrates from dimers to monomers. Take just before a meal. Start low dose, increase slowly. AEs Flatulence, bloating and diarrhoea due to undigested carbohydrates in colon. ON IT’S OWN DOES NOT CAUSE HYPOGLYCAEMIA If dual therapy, and hypoglycaemia occurs, will need to treat with pure glucose. ******* Abdominal distension and bloating Take just prior to meal
which best describes acarbose?
Sodium-Glucose Transporter Inhibitor (SGLT2 Inhibitor) It works by inhibiting the reuptake of glucose into the blood from the nephron. Glucose is excreted in the urine instead of going back into circulation. USED ON ITS OWN WILL NOT CAUSE HYPOGLYCAEMIA AEs Thrush, UTIs Not suitable for patients with kidney problems ******** Urinary tract infections Severe kidney problems
which best describes sitagliptin?
DDP-4 Inhibitor It works by preventing the cleavage of GLP-1, hence, increasing release of insulin from the pancreas (only when glucose is present). Reduces amount of glucose released by the liver. They inhibit glucagon release. USED ON ITS OWN WILL NOT CAUSE HYPOGLYCAEMIA Subcut injecton AEs Nausea and headache ********* Do not cause hypoglycaemia Given by injection Severe kidney problems – do not use
Biguanide First line treatment for DMII It works by inhibiting gluconeogenesis, hence reducing release of glucose from the liver. Also reduces glucose absorption from GIT, and increases glucose uptake in fat tissue and muscle tissue. Take with meals or directly after. Start low dose and increase slowly. DOES NOT CUASE HYPOGLYCAEMIA WEIGHT NEUTRAL AEs GIT upsets, lactic acidosis (serious but rare – kidney issues increase risk) ********* • May initially cause GI distress Contraindicated: undergoing testing using IV dye, kidney problems. • Lactic acidosis
which best describes exenatide?
Sulphnylurea It works by increasing the amount of insulin produced and released by beta cells of the pancreas. They do so by blocking the exit of potassium from the beta cell at the ATP sensitive calcium channel. Excess potassium in the cell leads to the depolarisation of the membrane. There is a subsequent influx of calcium. The raised intracellular calcium causes the emptying of insulin granules and the release of insulin. Needs residual function in beta cells to be effective Take just before a meal. CAN CAUSE HYPOGLYCAEMIA LINKED WITH WEIGHT GAIN AEs Hypoglycaemia ******** Weight gain, hypoglycemia
Which best describes canagliflozin?
glycated haemoglobin! what level is suggestive of hyperglycaemia and diabetes?
>7%
≤5%
pick the true comment
Glycosylated (or glycated) haemoglobin Glycosylated (or glycated) haemoglobin (haemoglobin A1c, Hb1c , or HbA1c, A1C) is a form of haemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic pathway by hemoglobin's normal exposure to high plasma levels of glucose. HbA1c of 7% or less should be set for all patients with type 2 diabetes Any reduction of HbA1c is of benefit even if the 7% target cannot be met HbA1c indicates glycaemic control during preceding 2–3 months; there is an association between the risk of microvascular complications and level of glycated haemoglobin. Monitor every 3–6 months.
glycated haemoglobin is a pointless measurement for long term observations because if you don't eat before the test it will make it go right down and ruin the results
ideal fasting glucose and a good target goal for a person receiving treatment for diabetes is <5.6mmol/L
ideal target of HbA1c (glycated haemoglobin) for someone undergoing treatment for diabetes is <7%
you've done great! this is the end of the quiz because I can't be bothered doing insulin questions right now.
this was a fun experience. T/F
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