21.1 Diabetes mellitus Flashcards
Describe the role of insulin in normal blood glucose control.
- Negative feedback loop
- Beta cells in the pancreas detect high glucose levels
- Insulin is released from beta cells in the silets of Langerhans
- Insulin acts on cells to increase glucose absoprtion from the blood and stimulates the liver to store glucose as glycogen
Describe the role of glucagon in normal blood glucose control.
- Negative feedback loop
- Alpha cells in the pancreas detect low blood glucose
- Glucagon is released from the alpha cells in the islets of Langherhans
- Glucagon causes liver to break down glycogen stores into glucose, and turn fat stores into glucose aka gluconeogensis
NB: glucagon is released when blood glucose is low and also in times of stress
What are normal blood glucose levels for diabetics and non-diabetics upon waking and before and after meals?
Describe type 1 diabetes.
- A chronic organ specific autoimmune disease
- Pancreas stops producing insulin
- Unknown cause, may be a genetic component, potentially linked to a virus e.g. enterovirus or coxsackie virus
- Blood glucose levels increase significantly, hyperglycaemia
- Life long insulin
- Some pts being offered pancreas transplants which cures the disease
Name the main symptoms of type 1 diabetes.
- Polyuria
- Polydipsia
- Weight loss
- Irritable
- Fruity breath
How may a patient present before they are diagnosed with type 1 diabetes?
- Diabetic ketoacidosis: cells produce ketones as a source of fuel, blood becomes acidic
- Can develop severe hypokalaemia which causes cardiac arrythmias
- Severe dehydration
Describe type 2 diabetes.
- Accounts for 90% of all diabetes diagnsoes
- Insulin is produced but is ineffective at the cell level
- Treatment is aimed at making insulin more effective (e.g. biguandes)
- As it progresses patients may be on drugs to stimulate the pancreas to make more insulin (e.g sulphonylureas)
- More of a genetic link with type 2 diabetes than type 1 diabetes
- Many type 2 diabetics go on to have insulin requirements as their body produces less insulin overtime
What are the 2 types of drugs that type 2 diabetics commonly take?
- Bigunades: increases insulin sensitivty of the body’s tissues e.g. Metformin
- Sulphonylureas: increase the amount of insulin produced by the pancreas e.g. Gliclazide
What is Liraglutide?
Brand name Saxenda
- Weight loss injections for type 2 diabetics
- Prescribed by the NHS in select circumstances
What is HbA1c?
- Glycated haemoglobin
- Provides an indication of the last 3 months of diabetic control
- Target for diabetics is 48mmol/mol aka 6.5% or lower
Apply the ASA classification to diabetic patients.
What are the major complications of diabetes?
What are the oral complications of diabetes?
- Increased periodontal disease
- Potential for increased caries due to more frequent snacking
- Poorer healing
- Increased susceptibility to infection (including opportunistic infection e.g. candida)
- Burning mouth syndrome
- Xerostomia
Describe the features of mild, moderate and severe hypoglycaemia, and the tx needed.
What should you include when taking the history of a diabetic patient?
- Type 1 or 2
- Usual management
- Level of control: last HbA1c, medications, how often they see nurse
- Pre-treatment: check blood glucose for certain tx (especially extractions), check how they are feeling, have they eaten, have they taken their normal medicaiton
- May be useful to know their signs of hypoglycaemia (can be unique to each pt, particularly for T1D)
