Diabetes Flashcards
Nephropathy
Kidney diseased by diabetes due to glomeruli becoming leaky and thus losing protein so makes kidney granular.
Tends to lead to retinopathy and severe neuropathy.
CV mortality 30x higher
Symptoms of diatetes
Polyurea
Thirst
Tiredness
Weight loss
Type 1
Inherited - autoimmune destruction of beta cells therefore insulin deficient.
Usual onset age 5 - 15
To diagnose need 2/3 of:
- Weight loss
- Short term sever symptoms
- High urinary ketones
Normal symptoms + :
- Acetone breath
- Nausea, vomiting & abdo pain
- Hyperventilation
- Lethargic & stupor (confused)
Insulin control
High target = risk of diabetes
Tight control = risk of hypoglycaemia
Type 2
Resistance to insulin
Normally due to obesity + lack of exercise (western lifestyle)
Increases chance of major CV issue by 3-4x
Why does type 2 increase major CV risk?
Increased BP and lipids.
Why can type 2 lead to type 1?
Insulin secretion declines as type goes on.
How is type 2 treated?
- Diet control
- Metformin - increase skel musc insulin uptake
- Suphonylurea - makes pancreas make more insulin
- Insulin
Stepwise where the longer the pt has has diabetes the more insulin makes up their tx.
e.g. undiagnosed or newly diagnosed then oral glucose makes up 100% of tx whereas diagnosed 10y ago then 50/50 split of oral glucose/insulin
Aims of type 1 tx?
Relieve symptoms
Prevent ketoacidosis
Prevent micro and macrovascular complications
Avoid hypoglycemia
Type 1 tx
Insulin 2x day + before meals
Ability to judge carb intake
Awareness of exercise lowing blood glucose level.
Hypoglycaemia management
Conscious=oral glucose
Uncon = Glucagon or IV glucose
Then check after 10 mins and follow up with long acting carbs (e.g. toast)
Need to be stable for 45 mins before leaving
Monitoring diabetes
Glucose - vascular and capillary
Ketones - blood and urinary
HbA1c
Diabetes diagnostic levels
Random plasma glucose >11.1mmol/l
Fasting plasma glucose>7mmol/l
HbA1c > 48mmol/l
OGTT - >7 before test and >11.1 after taking 75g glucose
What syndrome is more likely with type 1?
Sjorgen’s
Pt attends who is overweight and is getting recurrent infections. What could this indicate?
Type 2 diabetes
What is HbA1c
The amount of glucose bound to Hb. It indicates the average glucose levels over the past few months.
What factors of type 2 increase pt’s macrovascular complication risk?
Hypertension
Obesity
High thrombogenesis
Abnormal lipids
Hyperglycaemia
Insulin resistance
Diabetic ketoacidosis
Ketones produced when fasting state as liver breaks down fats. Ketones acidic.
Diagnosed by:
Hyperglycaemia
Venous bicarbonate<15mmol/l
Ketones - urinary ketone test
Pt may be hyperventilating due to decrease bicarb lowing CO2 levels.
DKA causes?
- Newly diagnosed/undiagnosed (unaware of how to control)
- Infections
- Not taken insulin
Hyperosmolar Hyperglycaemic State (HHS) / Hyperosmolar Non-Ketoic Coma (HONK)
Super high glucose levels that may build up in type 2 pt. Pt often dehydrated.
Hyperglycaemia >50mmol/l
Hyperosmolality >350mosmoles/l
Type 2 poorly controlled or newly diagnosed.
Hyperglycaemia signs
Thirst however high urination.
Blurred vision.
Recurrent infections.
Sweating, tremor, palps.
Lost concentration, tired, angry, sad, confused.
What does diabetes increase dental risk of?
Gingivitis
Perio
Caries
Candidiasis
Endocarditis
How may a pt anxious of dentist be affected by their diabetes?
Stress increases blood glucose levels however they may not then be able to control these increased levels.
Become sweaty and start shaking and may become confused in dental chair for example (hyperglycaemia).
How do you diagnose diabetes?
- Symptoms
- Random plasma glucose >11.1 mmol/l
- Fasting glucose >7 mmol/l
- HbA1c >48 mmol/mol
- OGTT
