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1. Name 5 symptoms of diabetesFatigue, unexplained weight loss, excessive thirst (polydipsia), excessive urination(polyuria), excessive eating/increase hunger (polyphagia), poor wound healing,

infections, blurry vision

2. Insulin is the first line of therapy for Type II diabetesNot true. Usually metformin

3. Describe 2 physiological etiologies (causes) of type I diabetes?Autoimmune disorder 

4. Name 4 test used to determine the level of glucose in the bodyUrine analysis

Fasting blood glucose level test / FPG (≥ 7.0 mmol/L (126 mg/dL)Haemoglobin A1c test (≥ 6.5%)

Oral glucose tolerance test / OGTT (Plasma glucose ≥ 11.1 mmol/L (200 mg/dL) twohours after a 75 g oral glucose load)

http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/  

5. Apart from monitoring glucose level and blood pressure, name 2 other annual test thatshould be carried out for diabetic patients. Why should these 2 test be done?

Dilated eye exam: An eye care professional uses eye drops to temporarily widen, or dilate, the black part of the patient's eyes (pupils) to see inside the eyes. Uncontrolleddiabetes can damage the eyes, harming vision and possibly leading to blindness.

Foot exam: A check of the foot's nerves and blood circulation. Uncontrolled diabetes

can lead to foot problems that may eventually require amputation.

6. Explain the rationale behind the mode of administration of insulin and the disadvantageof such administration methodTreatment of diabetes always involves injection of insulin (IV) because if taken orally,insulin would be destroyed in the stomach before it could get into the blood where it isneeded. Insulin therapy requires close monitoring and great deal of patient education as improper administration is quite dangerous. E.g. food intake reduced, less insulin required or maycause hypoglycaemic reaction, may promote small blood vessels disease. Creates riskbecause of the inability to continuously know a person’s blood glucose level and adjustthe insulin infusion appropriately.

http://en.wikipedia.org/wiki/Diabetes_management

7. Name 2 classes of Type II oral anti-diabetic medication. Give 1 example for each class.

Sulfonylureas (Glucovance is a combination medicine that contains glyburide andmetformin, Metaglip is a combination medicine that contains glipizide and metformin.)- Increase amount of insulin produced by pancreasThiazolidinediones Brand name: Actos (generic name: pioglitazone), Brand name:Avandia (generic name: rosiglitazone).

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- Helps to lower insulin resistance in cells, improving the way that body responds to insulin

8. Name primary site of action for the following classes of OHGA (oral hypoglycemicagents)

a. Alpha-glucosides inhibitor(acarbose) (saccharides that act as competitiveinhibitors of enzymes needed to digest carbohydrates), reduce impact of 

carbohydrates on blood sugar by preventing digestion of carbohydratesb. Biguanides(metformin) (reduce gluconeogenesis in the liver, and, as a result,

reduce the level of glucose in the blood)c. Sulfonylureas (ATP-dependent K+(KATP) channel on the cell membrane of 

pancreatic beta cells)d. Thiazolidinedones (activating PPARs (peroxisome proliferator-activated

receptors), a group of receptor molecules inside the cell nucleus, specifically

PPARγ  (gamma). The ligands for these receptors are free fatty acids (FFAs) and

eicosanoids. When activated, the receptor migrates to the DNA, activating

transcription of a number of specific genes.)

9. What is the rationale behind combination drug therapyMonotherapy often fails after a period of time, thus multiple drugs is needed to achieveglycemic control 

10. Describe the mechanism of action of Type II oral anti-diabetic drugs

11. Apart from medication dispensed how would you counsel a diabetic patient on self-care‘Have a healthy diet (if patient obese, recommend dietitian), eat consistent, well-balanceddiet consist of high in fiber, low in saturated fat, low in concentrated sweets, advise toexercise regularly, moderate alcohol consumption, quit smoking, self-monitored bloodglucose 

12. Name 3 complication in diabetes and describe how high level of plasma glucose couldlead to these complication

Diabetic hyperglycemic hyperosmolar coma - extremely high blood glucose levelswithout presence of ketones, condition of dehydration

- Kidney make up for high glucose levels in blood by allowing extra glucose to leave the

body through urine.

- Not enough fluid/fluid with sugar > kidney cannot get rid of extra glucose > glucose level

in blood increase > blood more concentrated than normal (hyperosmolarity)

- Hyperosmolarity: blood has high conc of salt(sodium), glucose and other substances

that normally cause water to move into the bloodstream > draws water out of body’s

organ(brain) > cycle of increasing blood glucose level & dehydration

Diabetic ketoacidosis - occurs when the body cannot use sugar (glucose) as a fuelsource because there is no insulin or not enough insulin. Fat is used for fuelinstead. Byproducts of fat breakdown called ketones build up in body.

- Glucose not available, fat is broken down (normally in type 1 diabetes)- Acids(ketones) build up in blood and urine when fat breaks down, high level of ketones

is poisonous (ketoacidosis)- BGL rise (>300mg/dL) because liver makes glucose to combat problem

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13. If a person is hyperglycaemic is he/she considered in diabetic? No

http://www.emedicinehealth.com/diabetes/article_em.htm  

Diabetes mellitus (DM): body cannot regulate the amount of sugar (glucose) in the blood.

Process

• Liver converts food into glucose

• Glucose release into bloodstream

• Healthy person – blood glucose regulated by several hormones (primarily insulin).

• Insulin produced in pancreas (organ between stomach & liver)

• Insulin allows glucose to move out of blood to cells throughout body where it is needed

for fuel

•

Diabetic person – do not produce enough insulin (type 1 diabetes) / cannot use insulinproperly (type 2 diabetes) or both

• Diabetes – glucose in blood cannot move efficiently to cells, therefore blood glucose

remains high. Starves cells that need glucose for fuel and harm organs/tissues exposed

to high glucose levels

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Type 1 diabetes (T1D/IDDM): The body stops producing insulin or produces too little insulin to

regulate blood glucose level.

- Usually diagnosed during childhood or adolescence. Referred as juvenile-onset diabetes

or insulin-dependent DM

- Can occur in older individual due to destruction of pancreas by alcohol/disease/removal

in surgery or progressive failure of pancreatic beta cells (cell that produce insulin)- Requires insulin treatment daily to sustain life

- Cause by body’s immune system that attacks the cell in pancreas that produces insulin

(autoimmune disorder)

Type 2 diabetes (T2D/NIDDM): Although the pancreas still secretes insulin, the body of 

someone with type 2 diabetes is partially or completely unable to use this insulin. This is

sometimes referred to as insulin resistance. The pancreas tries to overcome this resistance by

secreting more and more insulin. People with insulin resistance develop type 2 diabetes when

they fail to secrete enough insulin to cope with their higher demands.

- Usually diagnosed in adulthood after age 45. Referred as adult-onset diabetes or non-

insulin dependent DM but names no longer use as it occurs in younger people and some

people requires insulin therapy

- Controlled with diet, weight loss, exercise and oral medications (metformin; first line

treatment as it decreases mortality, acarbose, sulfonylureas, thiazolidinediones)

- Cause by strong genetics link (tends to run in the families), lifestyle, medical conditions

Gestational diabetes (GDM) is a form of diabetes that occurs during the second half of 

pregnancy.

Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition called

hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, theblood vessels of the kidneys, the nerves, and other blood vessels.

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When medications fail example drugs are no longer effective or safe for patients because of:

insulin will be needed to obtain satisfactory glucose control.

http://www.uptodate.com/contents/patient-information-diabetes-mellitus-type-2-insulin-treatment

A second medication may be added within the first two to three months if blood sugar

control is not adequate. "Adequate" control is defined as an A1C level less than 7% for mostpeople; insulin may be recommended early if the A1C remains elevated despite lifestyle

changes and diabetes pills, especially if the A1C is higher than 8.5%

Factors to consider for combination of oral agent therapy:

- Age, weight, renal impairment, hepatic disease