Diabetes Flashcards
What is the epidemiology of diabetes mellitus?
Estimated 5 million ppl with diabetes in UK by 2025.
Estimated 850,000 ppl in UK undiagnosed
12.3 million at risk of type 2 DM
A patient contacts you to update their medication list prior to an appointment for a dental extraction next week. In addition to his usual Metformin, he is now taking Gliclazide. He asks whether or not this will affect his dental treatment.
Does this patient suffer from type 1 or type 2 diabetes mellitus?
Type 2
Identify two differences between diabetes mellitus type 1 and 2.
age of onset: type 1 = younger
prevalence: type 2 more prevalent
aetiology: type 1 = autoimmune type 2 = insulin resistance/B cell dysfunction
Initial presentation: type 1 = loss of weight/polyuria/DKA: type 2 = hyperglycaemia, diabetic complications
association with BMI: usually reduced BMI in T1. Increased BMI in T2
Name two oral complications of diabetes mellitus (5)
- oral infections
- periodontal disease
- poor healing
- xerostomia
- neuropathic changes/changes in sensation.
Identify the main actions of metformin on the liver and muscle.
Decreases hepatic gluconeogenesis
Increases glucose uptake and utilisation in skeletal muscle
Increases sensitivity to insulin
A patient contacts you to update their medication list prior to an appointment for a dental extraction next week. In addition to his usual Metformin, he is now taking Gliclazide. He asks whether or not this will affect his dental treatment.
Can the extraction for this patient still go ahead as originally planned?
Yes
Give two treatment measures that are used in the management of hypoglycaemia in the dental setting.
Glucagon
Lucozade, or any other suitable example of high sugar substance
Hypostop
What is normal blood glucose?
fasting: 4.0-6.0 mmol/L Post prandial (2hrs after meal) <7.8mmol/L
What does each cell type release in the islets of langerhans?
Alpha cells - glucagon
Beta cells - insulin
Delta cells - somatostatin
When is insulin released?
What does insulin cause in 1) liver and muscle cells 2) fat cells 3) liver and kidney cells?
High blood sugars (e.g. after a meal) stimulate insulin release from pancreas.
1) liver and muscle cells
> incr storage of glucose as glycogen
> amino acid production from proteins
2) fat cells
> formation of fats from fatty acids + glycerol
3) liver and kidney cells
> inhibition of making glucose (gluconeogenesis)
overall, insulin increases storage of glucose, fat, amino acids
therefore, reducing concentration in circulating blood stream
When is glucagon released?
What does glucagon cause in 1) liver and muscle 2) liver and kidney cells?
Low blood sugars (e.g. fasting) stimulate glucagon release form the pancreas.
1) LIVER AND MUSCLE CELLS
> breakdown of glycogen to release glucose (glycogenolysis)
2) LIVER AND KINDEY CELLS
> stimulate gluconeogenesis
Overall, glucagon stimulates release of glucose form body stores to increase concentration in bloodstream.
What does insulin deficiency or resistance cause?
> Cells unable to absorb glucose despite high levels in blood.Glucagon release stimulated to try and increase glucose levels.Increased release of glucose from storage + gluconeogenesisIncreases blood sugars further but cells still unable to take up and use.
What does high levels of blood sugar in diabetic pts cause?
> Increased filtration of glucose by kidneysExcess glucose in renal tubules causes loss of water by osmosisResults in excess glucose being excreted in urine, with polyuriaPolydipsia results because of vol loss + due to osmotic effects stimulating thirst receptors.
What is polyuria?
Lots of urine
What is polydipsia?
Very thirsty
What are symptoms of diabetes mellitus? (7)
1) Polyuria
2) Polydipsia
3) Weight loss
4) Sx + signs of diabetic ketoacidosis
5) Lethargy
6) Blurred vision
7) Recurrent infections
How do you diagnose diabetes?
Random glucose >11.1 mmol/L
Fasting glucose >7.0 mmol/L
2 hr postprandial >11.1 mmol/L
HbA1c >4.8 mmol/mol
only pregnant use glucose tolerance test.
normally use HbA1c
What are the types of diabetes? (5)
- Type I DM –> failure to produce insulin
- Type II DM –> resistance to insulin
- Gestational DM –> pregnant women who have never had diabetes before but who have high glucose levels during pregnancy.
- MODY –> genetic defects leading to DM.
5. Secondary diabetes > pancreatic disease e.g. cystic fibrosis, pancreatomy > endocrine e.g. Cushings. Acromegaly > drug induced e.g. steroids > genetic