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with as many people IN THE CLASS as you want to. 1. Name 5 symptoms of diabetes Fatigue, 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 diabetes Not 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 body Urine 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) two hours 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 that should 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. Uncontrolled diabetes 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 disadvantage of such administration method Treatment 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 is needed. 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 may cause hypoglycaemic reaction, may promote small blood vessels disease. Creates risk because of the inability to continuously know a persons blood glucose level and adjust the 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 and metformin, Metaglip is a combination medicine that contains glipizide and metformin.) - Increase amount of insulin produced by pancreas Thiazolidinediones Brand name: Actos (generic name: pioglitazone), Brand name: Avandia (generic name: rosiglitazone).

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 hypoglycemic agents) a. Alpha-glucosides inhibitor(acarbose) (saccharides that act as competitive inhibitors of enzymes needed to digest carbohydrates), reduce impact of carbohydrates on blood sugar by preventing digestion of carbohydrates b. 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 PPAR (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 therapy Monotherapy often fails after a period of time, thus multiple drugs is needed to achieve glycemic 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-balanced diet consist of high in fiber, low in saturated fat, low in concentrated sweets, advise to exercise regularly, moderate alcohol consumption, quit smoking, self-monitored blood glucose 12. Name 3 complication in diabetes and describe how high level of plasma glucose could lead to these complication Diabetic hyperglycemic hyperosmolar coma - extremely high blood glucose levels without 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 bodys organ(brain) > cycle of increasing blood glucose level & dehydration Diabetic ketoacidosis - occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. 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

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 insulin properly (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

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 bodys 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 noninsulin 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, the blood vessels of the kidneys, the nerves, and other blood vessels.

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 most people; 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