diabetes Flashcards
diabetes mellitus vs diabetes insipidus
diabetes means pee alot
mellitus = glucose in pee (glucose regulation problem)
insipidus = no glucose in pee (renal function problem, lack of adh)
type 1 or type 2 diabetes mellitus more common
type 2 85%
type 1 vs type 2
o type 1 -> no insulin production
o type 2 -> poor response to insulin
what other medical conditions are diabetes related to?
infection
poor wound healing
stroke
MI
peripheral neuropathy and artery disease
retinopathy
diabetic foot
cataract
renal disease
how to test for diabetes?
high plasma glucose >11.1mmol/L
Glucose tolerance test
HbA1C >48mmol/molo (glycosylated haemoglobin)
what is glucose tolerance test?
given 75g of glucose and sugar level accessed after 2 hours
results can be normal, impaired fasting glucose or diabetes
if you are found to have impaired fasting glucose from a GTT test, what does it mean?
pre diabetic
what is glycosylated haemoglobin HbA1C??
used to MONITOR diabtes, tells you if sugar control has been good or bad for the past few weeks
o measure of how much glucose residue is stuck to the surface of Hb
o glucose residue increases with time, signifies increasing sugar concentration in blood
Ketoacidosis
body cannot access glucose for metabolism and energy so starts to metabolise fat which results in ketones and acid
what is GAD ICA IAA
- GAD = glutamic acid decarboxylase
- ICA = islet cell antibodies
- IAA = insulin auto antibodies
What does insulin resistance mean?
blood glucose constantly high so insulin becomes less sensitive, requires larger amounts of insulin to lower blood glucose levels
high basal insulin levels
B cell response to hyperglycaemia is inadequate
failure of gluconeogenesis suprresion
glucose movement is poorly repsonsive so glucose uptake is reduced
insulin resistance found in which type of diabetes
2
Diabetes related to medications
- corticosteroids (insulin antagonists)
- immune suppressants
- cancer meds
- antipsychotic meds
- antiviral
Diabetes related to which endocrine diseases
- Cushings (excess cortisol)
- Phaeochromocytoma (adrenaline tumour)
- Acromegaly (excess growth hormone)
Why? Because a change in hormone levels will change the ability of the body to handle glucose load
what is gestational diabetes
pregnant women, increased metabolism but once baby born back to normal
type 1 causes
autoimmune destruction of B cells (Lymphocytes attack pancreatic islets of Langerhans )
genetic + environment
is type 1 and 2 rapid/ chronic progression
type 1 - rapid
type 2 - chronic
in which type will there be ketoacidosis?
acute presentation
EMERGENCY
in type 1
rare in type 2
increase in GAD ICA and IAA indicates what?
Circulating antibodies indicates loss of pancreatic function : type 1 diabetes
is type 1 and type 2 more common in kids or adults
type 1 - kids but adults possible (LADA)
type 2 - adults but kids sometimes (MODY)
lada latent autoimmune diabetes in adult
mody mature onset diabetes in young
- polyuria (pee)
- polydipsia (thirst)
- tiredness
symptoms of type 1
symptoms of type 2
- impaired glucose tolerance
- hypertension
- obesity
- early and accelerated atherosclerosis
- retinal damage
- infections like oral candidiasis
- MI/stroke
insulin injections in which type
1 but 2 also can
how to manage diabetes?
education on diet and lifestyle more exercise less carbs
blood glucose targets
reduce risks from associated dieases using drugs
insulin injections
how is insulin injected
subcutaenously
either split mix or basal bolus
split mix vs basal bolus for insulin injections
- split mixed = less injections less controlled
- basal bolus = more injections more controlled
why do we give diabetes patients CVS drugs
high blood sugar levels for a period of time, your blood vessels can start to get damaged, glucose sticks to your red blood cells and builds up in your blood.
leading to eye, feet problems etc
o antiplatelet
o stains
o antihypertensives
why must exercise be planned for type 1 diabetic patients?
might risk hypoglycaemia
ideal HbA1C levels
6-10%
o if too high -> retinopathy
o if too low -> hypoglycaemia
*glycosylated haem used to monitor sugar control over time
why is retinopathy a complication of diabetes?
small blood vessels in the eye get swollen
type 1 diabetes monitoring machine name
closed loop glucose monitoring
continuous glucose monitoring
type 2 diabetes tx
- avoid CHO and fat diet
- bariatric surgery
- medications
first line drug for t2 diabetes
metformin
enhances cell insulin sensitivity
reduces hepatic gluconeogenesis
what are gliptins
DDP-4 inhibitors (Gliptins)
drug for t2 diabetes
- blocks metabolism of incretin
- incretin stays in circulation for longer
what is incretin
stimulates a decrease in blood glucose levels,
stimulates insulin release
Sulphonylureas
drug for type 2
- increases pancreas insulin secretion
- but can cause hypoglycaemia
Complications of diabetes treatment
in type 1, inject insulin but dont consume food -> acute hypogly
in typw 2, take med sulphonylurea -> too much insulin secreted can cause acute hypogly
when to prescribe additional insulin
Type 1 requires more insulin during surgery
Type 2 requires insulin after operation for wound healing and prevent infection
why is fasting before surgery a problem for type 1 diabetes
o might lead to acute severe hypoglycaemia since insulin taken but cannot eat food
o need insulin to prevent ketosis
o usually admitted to hospital for glucose drip
what metabolic changes associated with surgery
o higher demand for energy
o adrenaline
o cortisol
o hormone changes aggravate diabetes
o more glucose formed less muscle uptake
o metabolic acidosis likely
in dentistry what do you have to look out for in diabetic patients
food intake after procedure may be disrupted, patient may not want to eat after a procedure but they MUST otherwise hypogly
acute emergencies ketoacidosis or acute hypogly
infection risk
poor wound healing
