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Systemic Disease in Dentistry > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Describe the prevalence of diabetes in Northern Ireland

A
  • 4% population has diabetes
  • Prevalence increased of 33% in last 5 years
  • 90% have T2DM and 10% have T1DM
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2
Q

Name 4 reasons why diabetes is so important

A
  1. Considerable morbidity associated with disease
  2. Retinal disease may result in blindness
  3. Dialysis is end stage diabetes
  4. Heart disease and stroke common
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3
Q

What is a very simplified definition of diabetes?

A

High blood sugar

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4
Q

Describe the HbA1c test

A
  • Average plasma glucose measured over 8-12 weeks
  • Can be performed at any time of day and does not require fasting
  • Diabetes > 48mmol/mol
  • > 42mmol/l is high risk of developing diabetes
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5
Q

Name 5 types of primary diabetes

A
  1. T1DM
  2. T2DM
  3. Gestational
  4. Drug induced
  5. Genetic
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6
Q

Name 5 types of secondary diabetes

A
  1. Pancreatitis
  2. Cushing’s syndrome
  3. Acromegaly
  4. Phaeochromocytoma
  5. Hyperthyroidism
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7
Q

Describe T1DM

A
  • Autoimmune destruction of pancreatic B-cells
  • Typically presents < 40 years with peak at 12 years
  • Presents with polyuria, polydipsia, weight loss and ketosis
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8
Q

Describe T2DM

A
  • Insulin resistance with or without pancreatic failure
  • Typically presents > 40 years with peak at 60 years
  • May be asymptomatic
  • Presents with hyperglycaemia symptoms and fatigue
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9
Q

Describe the 4 types of insulin used in treatment of T1DM

A
  1. Rapid acting
  2. Short acting
  3. Intermediate acting
  4. Long acting
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10
Q

Name an example, onset of action (mins) and duration of action (hrs) of rapid acting insulin

A

Novorapid
15 mins
2-5 hours

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11
Q

Name an example, onset of action (mins) and duration of action (hrs) of short acting insulin

A

Actrapid
30-60 mins
8 hours

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12
Q

Name an example, onset of action (mins) and duration of action (hrs) of intermediate acting insulin

A

Insulatard
1-2 hours
16 hours

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13
Q

Name an example, onset of action (mins) and duration of action (hrs) of long acting insulin

A

Lantus
No peak onset (slow release)
18-24 hours

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14
Q

What is the first line treatment of T2DM?

A

Diet and lifestyle advice

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15
Q

Name 4 drugs used in the treatment of T2DM

A
  1. Metformin
  2. Gliclazide (sulphonylureas)
  3. Acarbose (a-glucosidase inhibitor)
  4. Pioglitazone (thiazolidinedione)
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16
Q

Describe the mechanism of action and side effects of metformin

A
  • Reduce hepatic gluconeogenesis
  • Increase muscle glucose uptake
  • Nausea, diarrhoea, lactic acidosis
17
Q

Describe the mechanism of action and side effects of gliclazide

A
  • Stimulate B-cells to produce insulin

- Hypoglycaemia and weight gain

18
Q

Describe the mechanism of action and side effects of acarbose

A
  • Inhibits breakdown of carbohydrates thus delaying glucose uptake
  • Bloating, flatulence, diarrhoea
19
Q

Describe the mechanism of action and side effects of pioglitazone

A
  • Improve insulin sensitivity

- Fluid retention, heart failure, weight gain, bladder cancer

20
Q

Describe the Incretin System

A
  • Liver senses glucose has been taken orally
  • Stimulates production of GLP1
  • GLP1 stimulates pancreas to make insulin in appropriate manner
  • Insulin production increases
21
Q

Name 2 drug therapies used to target the incretin system

A
  1. GLP-agonists

2. DPP4 inhibitors

22
Q

Why do DPP4 inhibitors affect the incretin system?

A

DPP4 is responsible for the breakdown of GLP1 so inhibitors prevents GLP1 breakdown and increases presence in the body

23
Q

With regards to normal glucose handling, describe how SGLT2 inhibitors can be used as a treatment for T2DM

A
  • Glucose is filtrated in the glomerulus
  • Majority of glucose is absorbed by SGLT2 receptor in PCT
  • Remaining glucose absorbed by SGLT1 receptor in descending limb of Loop of Henle
  • SGLT2 inhibitors prevent resorption of glucose from PCT
  • This leads to increased urinary glucose extraction
  • Reduces the blood-glucose level
24
Q

Name 3 emergencies in diabetes

A
  1. Diabetic ketoacidosis
  2. Hyperosmolar hyperglycaemia state
  3. Hypoglycaemia
25
Q

Name 3 things which make up diabetic ketoacidosis

A
  1. Hyperglycaemia (glucose > 11.1 mmol/l)
  2. Acidosis (ph < 7.3)
  3. Ketosis (urinary or capillary)
26
Q

Describe the management of diabetic ketoacidosis

A
  • IV fluids and insulin
  • Potassium
  • Treat underlying cause e.g infection
  • Careful monitoring
  • Education
27
Q

What is hypoglycaemia?

A

Low blood glucose (< 4mmol/l)

28
Q

Describe the symptoms of hypoglycaemia

A

Sweating, Pallor, Anxiety, Tremors
Confusion, Fatigue, Headache
Slurred speech, Incoordination, Drowsy, Coma

29
Q

Describe the treatment of hypoglycaemia

A
  • Treat with quick acting carbohydrate (glucotabs)

- Follow up with long acting carbohydrate (meal / bread)

30
Q

Name 5 common complications of diabetes

A
  1. Periodontitis
  2. Dry mouth
  3. Altered taste sensation
  4. Oral infection
  5. Poor oral wound healing
31
Q

Name 4 things to consider when planning a procedure

A
  1. Medications the patient is on
  2. How long the procedure is
  3. Time of the procedure
  4. Will they be able to eat after the procedure
32
Q

Describe 3 steps to take if a patient is taking insulin or gliclazide

A
  1. Reduce long acting insulin the evening before the procedure
  2. Hold short acting insulin and gliclazide on the day of test
  3. Put patient first on the morning list

Systemic Disease in Dentistry (22 decks)

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