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HHD 2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is Diabetes Mellitus?

A

a group of metabolic diseases in which ther are high blood sugar levels over a prolonged period

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2
Q

What are some symptoms of a high blood sugar?

A

frequent urination
increased thirst
increased hunger

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3
Q

Name some acute complications of diabetes?

A
  • diabetic ketoacidosis
  • non-ketotic hyperosmolar coma
  • death
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4
Q

List some long-term complications of diabetes

A
  • heart disease
  • stroke
  • chronic kidney failure
  • foot ulcers
  • damage to the eyes
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5
Q

What is the essential cause of diabetes?

A
  • pancrease not producing enough insulin
    OR
  • body not responding properly to the insulin that is produced
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6
Q

What are the 3 main types of diabetes mellitus?

A

T1DM
T2DM
Gestational diabetes

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7
Q

What is the cause of T1DM? Briefly state the pathophysiology

A

Causes is unknown

results from the pancreas failure to produce enough insulin

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8
Q

T1DM was previously referred to as…

A

Juvenile diabetes
Insulin-dependent diabetes mellitus

T2DM patients can also become dependent on insuling hence why this name is no longer used/appropriate

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9
Q

The alpha cells in the islets of langerhans produce …

A

glucagon

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10
Q

The Beta cells of the islet of langerhans produce…

A

insulin

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11
Q

The delta cells of the islets of langerhans produce…

A

somatostatin

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12
Q

What is the pathophysiology of T2DM?

A

begins with insulin resistance, a condition in which cells fail to respond to insulin properly

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13
Q

T2DM was previously referred to as …

A
  • non insulin depenent DM
  • adult onset diabetes

T2DM patients can eventually become dependent on insulin

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14
Q

What is the primary cause of T2DM?

A

excessive weight and not enough exercise

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15
Q

Who does gestational diabetes mainly affect?

A

pregnant women without a previous history of diabetes

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16
Q

Compare and contrast features of T1DM and T2DM

A

T1DM:
* Sudden onset
* onset mostly in children
* thin/normal body size
* ketoacidosis is common
* autoantibodies are usually present
* endogenous insulin is either low or absent
* 50% concordance in identical twins
* 10% prevalence

T2DM:
* gradual onset
* onset mostly in adults
* ketoacidosis is rare
* autoantibidies are absent
* endogenous insulin may be normal, decreased or increased
* 90% concordance in twins (highlights genetic risk)
* 90% prevalence

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17
Q

What are the main symptoms of diabetes?

A

Central:
* polydipsia (thirst)
* polyphagia (loss of glucose; eating more to compensate for glucose loss)
* lethargy
* stupor
* headache

Systemic:
* weight loss

Respiratory:
* Kusssmauls breathing- hyperventilation

Breath:
* smell of acetone- fruity smell of acetone

Eyes:
* blurred vision

Gastric:
* nausea
* vomiting
* abdominal pain

Urinary:
* polyuria
* glycosuria (glucose in urine)

Vasular:
-slow healing of cuts

Skin:
-itchy skin

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18
Q

What is ketoacidosis?

A

this is the result of a insulin resistance/lack of insulin; where the body is unable to use sugars fo energy and thus fat is used instead. Chemicals called ketones are a biproduct of the break down of fat

Ketones cause blood to become more acidic leading to respiratory compensation to breathe out - hyperventilation

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19
Q

What ate the classic symptoms of untreated diabetes?

A
  • weight loss
  • polyuria
  • polydipsia
  • polyphagia
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20
Q

What is the effect of prolonged high blood glucose on the eye?

A

leads to glucose absorpion in the lens of the eye

this leasds to changes in the shape of the lens resulting in vision changes

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21
Q

A number of skin rashes that can occur in diabetes are collectively known as…

A

diabetic dermadromes

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22
Q

The major long term complications of diabetes relates to damage to __________.

A

blood vessels

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23
Q

Diabetes doubles the risk of ________ disease

A

cardiovascular

includes:
CAD
macrovascular disease (stroke)
Peripheral vascular disease

75% of deaths in diabetes are due to coronary artery disease (affects blood vessels that supply the heart)

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24
Q

The primary complication of diabetes is due to damege in small blood vessels. Give examples of tissue/organs most likely to be affected by small vessel damage

A
  • eye
  • kidney (glomerulus)
  • nerves (have their small blood supply)
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25
Q

What is the cause of diabetic retinopathy? What is the consequence of this condition?

A

damage to blood vessels in the retina of the eye

gradual vision loss, blindness

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26
Q

What are the consequences of diabetic nephropathy?

A
  • tissue scarring
  • urine protein loss (frothy urine)
  • eventually CKD, sometimes requiring dialysis or kidney transplant
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27
Q

What is the most common complication of diabetes?

A

diabetic neuropathy

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28
Q

What are the symptoms of diabetic neuropathy?

A
  • numbness
  • tingling
  • pain
  • altered pain sensation which can lead to damage to the skin

Diabetes related foot problems- diabetic foot ulcers; difficult to treat often requiring amputation

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29
Q

What is the result of proximal diabetic neuropathy?

A
  • painful muscle wasting
  • muscle weakness
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30
Q

What is the function of insulin?

A

principle hormone that regulates the uptake of glucose from the blood into the cells of the body especially liver, adipose tissue and muscle

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31
Q

Insulin acts via what receptor in smooth muscle cells?

A

Insulin like growth factor receptor 1
IGF-1 receptors

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32
Q

What are the main ways in which the body obtains glucose?

A
  • intestinal absorption of food
  • breakdown of glycogen
  • gluconeogenesis
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33
Q

What is glycogen?

A

storage form of glucose found in the liver

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34
Q

What is gluconeogenesis?

A

generation of glucose from non carbohydrate substrates in the body

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35
Q

What are the physiological effects of insulin on the body?

A
  • inhibits the breakdown of glycogen or the process of gluconeogenesis
  • stimulates transport of glucose into muscle and fat cells
  • stimulate storage of glucose in the form of glycogen
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36
Q

What is the effect of low glucose levels in the body?

A
  • glycogen breakdown
  • gluconeogenesis
  • decreasesd insulin release from beta cell
  • release of glucagon from alpha cells
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37
Q

What is the physiological effect of glucagon on the body?

A
  • stimulates break down of glycogen
  • increased blood glucose levels
  • can stimulate gluconeogenesis ?
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38
Q

What is the net effect of persitently high blood glucose levels (include biochemical effects)?

A
  • poor protein synthesis
  • breakdown of fat storage (ketoacidosis)
  • kidneys will reach a threshold of reabsorption of glucose; therefore glycosuria
  • increases osmotic pressure of urine- polyuria- increased loss of fluids
  • loss of fluids will be replaced osmotically by water held in body cells and other body compartments (dehydration)
  • dehydration is then compensated for with polydipsia
39
Q

What is T1DM characterised by?

A

the loss of insulin producing beta cells in the islet of langerhans in the pancreas
leads to insulin deficiency

40
Q

T1DM can be classified as either ________ or ____. State the more dominant class.

A

idiopathic (unknown)
immune mediated
Majority of T1DM is of the immune mediated nature

41
Q

Briefly describe what the immune mediated form of T1DM entails

A

A T-cell mediated attack which leads to the loss of beta cells and thus insulin

42
Q

In T1DM, unlike T2DM, what remains unaffected?

A

sensitivity and response to insulin

there just isn’t enough insulin being produced

43
Q

There is a genetic component to T1DM. What genes have been implicated in the risk of developing diabetes?

A

HLA genotype

44
Q

In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors such as …

A

viral infection
diet

45
Q

T2DM is characterised by insulin resistance. What does this mean?

A

this is when there is a defective resoonse of body tissues to insulin; this is believed to involve the insulin receptors

46
Q

What is th predominant abnormality in the early stage of T2DM?

A

reduced insulin sensitivity

47
Q

What are the main causes of T2DM?

A

lifestyle factors (diet, exercise, obesity, stress)
genetics

48
Q

Outline dietary factors which contribute to the development of diabetes

A
  • sugar-sweetened drinks
  • types of fats in diet
  • eating lots of white rice may increase the risk of diabetes
  • lack of exercise beliebe to cause 7% of cases
49
Q

What types of fat increased the risk of T2DM?

A

Saturated fats
Trans fatty acids

50
Q

What kinds of fats decrease the risk of developing T2DM?

A

polyunsaturated fats
monounsaturated fats

51
Q

What are the causes of gestational diabetes?

A
  • relatively inadequate insulin secretion
  • inadequate responsiveness to insulin

GD may improve or disappear after delivery

52
Q

What are the management strategies for gestational diabetes ?

A
  • dietary changes
  • blood glucose monitoring
  • in some cases, insulin may be required
53
Q

What are the risks of gestational diabetes?

A
  • macrosomia (high birth weight)
  • congenital heart defects
  • central nervous system abnormalities
  • skeletal muscle malformations
54
Q

Briefly describe the caues of macrosomia in GD

A

high blood glucose levels in mother
brings extra glucose to the baby
causes the baby to put on weight

55
Q

Respiratory distress syndrome is a complication observed in children who’s mothers have GD. Briefly describe the pathology of this

A
  • increased glucose levels in baby
  • this leads to increased levels of insulin in babys blood (may come from mother who is only insulin resistant?)
  • insulin may inhibit surfactant production by type II alveolar cells
    *

surfactant- lipoprotein secreted by type II cells
increased the surface tension in the alveoli when no air is present
keeps them open

56
Q

Infanst of mothers with GD are at an increased risk of hyperbilirubinaemia. True or false

A

True

may result from increased red cell destruction

57
Q

Perinatal death is a severe consequence of GD. Why does this occur?

A

due to poor placental perfusion due to vascular impairment

(diabetes damages microvasculature)

58
Q

When is labour induction indicated in GD?

A

when there is decreased placental function

59
Q

When are c-sections indicated for GD patients?

A
  • marked fetal distress
  • risk of injury associated with macrosomia such as shoulder dystocia
60
Q

How can diabetes increase the risk of periodontal disease?

A
  • microangiopathy (diseased microvasculature) can alter antigenic challenge -infection?
  • altered cell mediated immune response and impaired neutrophil chemotaxis- ability to fight off infection
  • increased calciumand glucose leads to plaque formation
  • increased collagen breakdown (accumulation of MMPs, metalloproteinases)

gingiva is 60% collagen
increased presence of MMPs leads to break down of gingiva

impaired angiogenesis is caused by action of MMPs in diabetes

61
Q

What are some oral complications of diabetes?

A
  • xerostomia is common reason is unclear
  • tenderness, pain and burning sensation of tongue
  • enlargment of parotid gland with sialosis
  • increased caries prevalence (xerostomia, glucose)
  • hyperglycaemia shows a positive association with dental caries
62
Q

What is sialosis?

A

enlargment of major salivary gland
normal gland tissue is replaced by adipose tissue

63
Q

There is an increased risk of infection in patients with diabetes. Briefly outline some reasons for this

A
  • reason unknown but macrophage metabolism is altered with inhibition of phagocytosis
  • peripheral neuropathy and poor peripheral circulation
  • immunological deficiency
  • high sugar medium
  • decreased production of antibodies
  • candical infections more common, adding to effects with xerostomia

increased risk of dental infections

64
Q

There is delayed wound healing in patients with diabetes. Why is this? What is an oral implication of this

A
  • due to microangiopathy (damaged microvasculature) and utilisation of protein for energy, may retard the repair of tissues - gluconeogenesis will divert use of proteins which could be otherwise used for wound healing
65
Q

Delayed wound healing increase the prevalence of ____________ in dentistry

A

dry socket

66
Q

What are the side effect of drugs such as glicazide or chlopropamide used to treat diabeters?

A

-sulfonylurea (stimulate release of insulin from pancreas)
-sulfonylureas may be associated with a lichenoid reaction

67
Q

Patients with diabetes can present with pulpitis for no obvious reasons. Why is this the case?

A

nerve plexuses that occupy the pulp are at risk of inflammation

there is also vascular degeneration; vessels that supply the nerves in the pulp are damanged

68
Q

Oral ulcers are a result of …

A

a breakdown in the epithelial lining

69
Q

List the dental management considerations that should be made for a diabetic patient

A

MH:
* glucose levels
* frequency of hypoglycaemic episodes (consequence of medication)
* medication, dosage and times
* consultation

Scheduling of visits:
* morning appointments
* do not coincide with peak activity (hypoglycaemia)

Diet
* ensure patient has eaten normally and taken medications as usual

Blood glucose monitoring:
* should be measured before the start of appointment

Prophylactic antibiotics:
* [at an increased risk of infection]
* establish infection
* pre-operation contamination wound
* makor surgery

70
Q

What considerations should be made for diabetic patients during dental treatment?

A
  • hypoglycaemic attack
  • hyperglycaemia
71
Q

What considerations should be made for diabetic patients after dental treatment?

A
  • infection control
  • dietary intake
  • medication e.g. aspirin
72
Q

What are salicylates contradinidcated for prescription to diabetic patients in the dental surgery?

A

this is because they increase insulin secretion and sensitivity

As well as diabetic medication, this can lead to hypoglycaemia in patients

73
Q

What is the cause of neurological symptoms of hypoglycaemia?

A

the brain can only access glucose for metabolism
does not metabolise proteins or fats

74
Q

What are the initial signs of hypoglycaemia?

A

mood changes
decreased spontaneity
hunger
weakness

75
Q

What are the signs of hypoglycaemia (after initial signs)?

A

Fight/flight

sweating
incoherence
tachycardia

76
Q

Hypoglycaemia can result in…

A

unconsciousness
hypotension
hypothermia
seizures
coma
death

77
Q

If a patient is conscious and able to swallow, how would you manage a hypoglycaemic event?

A
  • sugar drink, 150ml carbonated drin
  • 2 tea spoons of sugar in water
  • orange squash
  • repeat 10-15 minutes
78
Q

If a patient is drowsy, how would you manage a hypoglycaemic event?

A
  • sublingual carbohydrate gel
  • hypostop gel (10g) glucose
  • repeat 10-15 minutes
79
Q

If a patient is very drowsy or unconscious, how would you manage a hypoglycaemic attack?

A
  • glucagon 1mg IM/subcutaneous + sugary drink
  • check blood glucose rises above 5.0mmol in 10 minutes
80
Q

If a patient remains unconscious and unresponsive to glucagon in 2-3 minutes, what should you do?

A
  • call ambulance
  • monitor airway and pulse
81
Q

In a severe hyperglycaemic event, ketoacidosis may develop. What symptoms accompanies this condition?

A
  • nausea
  • vomiting
  • abdominal pain
  • acetone odor
82
Q

How would you manage an hyperglycaemia in an emergency?

A
  • seek medical intervention immediately
  • insulin administration
  • while in emergency give glucose first (difficult to differentiate between hypo and hyper); small amount is unlikely to cause significant harm
83
Q

How is diabetes diagnosed?

A
  • fasting plasma glucose levels >/=7mmol/L /126mg/dL
  • plamsa glucose >=11mmol/L(200mg/dL) 2 hours after 75g oral glucose load in a GTT
  • symptoms of a high blood sugar and casual plasma glucose
  • glycated hemoglobin (HbA1c) >/= 48mmol/mol
    *

GTT- glucose tolerance test

84
Q

What is an oral glucose tolerance test?

A

measures the bodys ability to metabolise glucose

85
Q

When is an OGTT most commonly done?

A

to check for gestational diabetes

86
Q

How is an OGTT performed?

A
  • pt is asked to fast for 8-12 hours
  • blood is drawn to test the fasting blood glucose level
  • glucose drink is administered
  • blood samples drawn for 3 times with a time interval of 1 hour
87
Q

What amount of glucose should be administered in a standard OGTT?

A

75/100 grams of glucose

88
Q

What is the OGTT result of a patient withoit diabetes?

A

Fasting value <6mmol/L
at 2 hours, under 7.8mmol/L

89
Q

What is the OGTT result for people with an impaired glucose tolerance?

A

Fasting value- 6.0-7.0mmol/L
at 2 hours 7.9-11.0mmol/L

90
Q

What the OGTT results of a diabetic patient?

A

fasting levels: >7.0mmol/L
at 2 hours: over 11mmol/L

91
Q

What are the levels of HbA1c in a normal patient (mmol/mol and DCCT%)?

A
  • <42mmol/mol
  • <6.0%
92
Q

What are the levels of HbA1c in a diabetic patient (mmol/mol and DCCT%)?

A
  • > /= 48mmol/mol
  • > /= 6.5%
93
Q

What is the management of diabetes?

A
  • lifestyle: nutrition, exercise, diet control to maintain BP
  • medication
  • surgery (for symptoms); pancreas transplant, kidney transplant, weight loss surgery

HHD 2 (37 decks)

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