diabetes Flashcards
uses of blood glucose
muscle storgae enegy source storage of fat liver storgane energy for CNS/brian excretion in utine
diabetes mellitus
metabolic disorder of carbohydrate metabolism
characteristics of diabetes mellits
hyperglycaemia (increased blood glucose)
high mrbidity and mortality
blood glucose levels normal vs diabetes and after meal
Normal fasting conditions - 3-5mmol/l - less than 10mmol/l 90 mins post food Diabetic fasting conditions - 4-7mmol/l - greater than 20mmol/l - hyperglycaemia
signs of diabetes
- blurry vision
- increase thirst and need to urinate
- feeling tired or ill
- recurring skin, gum, bladder infections
- dry, itchy skin
- unexpected weight loss
- slow healing cuts and bruises
- loss of feeling in hands/feet
types of diabetes
1) Type I
- insulin dependant
2) Type II
3) Gestational diabetes
4) impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)
- prediabetic conditions
type 1 diebtees
heritable genetic component
- lack of insulin production
affects islets of langerhams
beta cells killed by antibodies therefore lack of insulin
type 2
non insulin dependant or adult onset
affects production of insulin or response to insulin
- genetic and environmentals succeptibilty
obesity implicated
main stymptoms of type 2 and what do they man
1) Polyuria
- frequent urination due to osmotic diuresis
2) Polydipsia
- increased thirst and increased fluid intake due to polyuria
3) Polyphagia
- increased appetite
Other symptoms
- dry mouth
- itchiness
- increased incidence of thrush eg candida
- cramps
- skin infections
gestational diabetes
occurs in pregancies
predisposing factors to gestational diabetes and symptoms
- age (generally 35 over has a risk)
- ethnic group
- obesity
no clear sytoms
sometimes classic diabetes once
cause of gestational diabetes
- hormonal changed can make cells less responsive to insulin
- increased resistance to insulin
Increased blood glucose
Long term effect - larger babies
- mum at risk of type 2 diabetes
prediabetes
precursor to diabetes
associated with obestity0
- abnormally high blood glucose but not enough symptoms to diagnose
forms of prediabetes
1) impaired fasting glycaemia
2) impaired glucose tolerance
impaired fasting glycaemia
elevated fasting blood glucose but not high enough to classify as diebetes
impair glucose tolerance
abnormally elevated blood glucose after eting
how to test for diabetes
fasting plasma glucose
oral glucose tolerance test
random plasma glucose test
fasting plasma glucose test
- measures blood glucose when the person has not eaten for at least 8 hours
- detects pre/diabetes
oral glucose tolerancetest
- measures glucose after the individual has fasted for at least 8 hours and 2 hours after consuming. a glucose containing drink
- detects both
random plasma glucose test
- casual plasma glucose test i.e. measures glucose irrespective of whether the person has eaten or not
- diagnose diabetic only
- generally monitoring rather than diagnosis
Long term tests
glycated haemoglobin’s A1c
Fructosamine
glycated haemoglobin’s A1c
haemoglobin binds to glucose and becomes glycated
more in blood the more binds irreversibly
gives indication of avg glucose levels for 8-12 weeks
- normal is 3.5-5.5%
- diabetes is 6.5%
fructosamine test
Glycated serum protein, Glycated Albumin
- formed from serum proteins such as albumin (reaction between fructose and amine)
- measured fructose with these protein levels
used in cases of
- blood loss
- haemolytic anaemia
- sickle cell anaemia
- gives an average result over the last 2-3 weeks
management of type 1
- insulin (essential)
- exercise
- diet (low in fat, cholesterol and simple sugar)
management of type 2
- weight reduction
- diet
- exercise
if not successful above then - oral hypoglycaemic medications and then insulin
- insulin may not work due to susceptibility of peripheral tissue receptors
treatments for diabetes
oral hypoglycaemic agents
- metaformin
- sulphonylurease
metafromin effects and side effects
can be used for both types
inhibits glucose production by the liver (gluconeogenesis)
- useful in patients who are obese
Unwanted effects
- GI disturbance
- lactic acidosis (contraindicated for those with renal severe… conditions)
sulphonylurease
increases insulin production in pancreas long lasting effects Unwanted effects - appetite stimulant = weight gain - hypoglycaemia - GI upsets - potentially teratogenic (do not use in pregnancy or planning one)
diabetes and oral health
gum disease common
results in periodontitis and gingivitis
folles with tooth decay
other dental problems
1) lack of saliva
- bacteria and residues not washed
- antimicrobial effect of saliva decreases
- increased oral infections (eg thrush common in diabetes)
2) dental hygiene, diabetes and heart problems
- bacteria can enter blood stream (endocarditis)
- cholesterol build up in blood stream (atherosclerosis)
also increased bleeding time, longer to heal
diabtes and smoking
- higher risk of periodontitis
- smoking impairs blood flow and affect healing after dental procedure
- age increases risk
- increased risk of morbidity and premature deaths
