Diabetes Flashcards
What is diabetes mellitus and what is the most common type?
abnormality of glucose regulation
type 2
What is diabetes inspidius?
abnormality of RENAL FUNCTION (WATER)
What does chronic hyperglycaemia increase the risk of?
increases the risk of microvascular (capillaries) complications and long-term macrovascular (arteries. organs) disease
What can be tested to check for diabetes mellitus?
What vaules are diabetic?
Random Plasma Glucose (RPG)
* >11.1mmol/L on 2 occasions is diagnostic of DIABETES
Fasting Plasma Glucose (FPG)
* >7mmol/L
Glucose Tolerance Test GTT indicated if fasting sample indicates Impaired Fasting Glucose (prediabetic state)
HbA1C
* >48mmol/mol (6.5%)
Does not require a fasting sample
What is the GTT?
glucose tolerance test - 75g fixed glucose load given to fasting patient and sugar levels assessed afterwards
What are the prediabetic values (IFG) before test and 2 hours after GTT test?
FPG - 6.1-7mmol/L
2 hour - 7.8 - 11.1mmol/L
What is type 1 diabetes mellitus (T1DM)?
INSULIN DEFICIENCY
* Autoimmune destruction of pancreatic B cells
What is the aeiteology of T1DM?
interplay between genetic and environmental factors
Why does clinical presentation vary in age for T1DM?
Rate of destruction of pancreatic B cells determines the clinical presentation
80-95% of B pancreatic B cells destroyed by the time of presentation
What is ketoacidosis?
Body cells cannot access glucose for metabolism so the start to metabolise fat which results in Ketones as end product.
ketone bodies break down into acid therefore increasing acid levels in blood which is fatal
What low biomarker levels indicate low insulin secretion in T1DM?
low c-peptide levels
What is the peak age incidence for T1DM?
Childhood/adolescence onset
Peak incidence 10-14yrs - up to 60% cases occur AFTER age 16
What is adult T1DM called?
LADA - latent autoimmune diabetes in Adults (>25 yrs of
age)
What increased antibodies is associated with T1DM?
which one specifically adult(LADA)
GAD - adult
ICA
IAA
What are the characteristics of adult T1DM?
- less weight loss, less ketoacidosis
- may masquerade as ‘non-obese’ type 2
- variable period until insulin required
What are the symptoms of T1DM?
- polyuria
- polydipsia
- tiredness
What can T1DM acutely present as?
- Hyperglycaemia with diabetic symptoms
- Ketoacidosis
What is T2DM strongly associated with?
obesity & inactivity
What is the aetiology of T2DM?
strong family history
What is T2DM?
characterized by defective and delayed insulin secretion and not effective postprandial suppression of glucagon
reduced insulin receptor sensitivity
What medications can cause hyperglycaemia and lead to development of diabetes?
- Corticosteroids
- Immune suppressants – Cyclosporin, Calcineurin inhibitors (Tacrolimus, Serolimus)
- Cancer medication – Imatinib, Nilotinib
- Antipsychotic Medicines – clozapine, olanzapine, quetiapine
- Antiviral – protease inhibitors
What surgery helps in terms of T2DM remission?
baraiatric
What happens in T2DM mechanism?
- B cell response to hyperglycaemia is inadequate
- elevated basal insulin levels
- failure of gluconeogenesis suppression
- insulin stimulated glucose uptake is reduced
What other metabolic changes occur in T2DM?
- Incretins – inadequate release or response to
these (GLP-1, GIP)
What type of fat is associated with T2DM?
visceral
What do incretins do?
hormones that stimulate insulin release
What are the effects of T2DM?
- Hypertension
- Obesity with abdominal distribution
- Dyslipidaemia (High LDL, Low HDL)
- Procoagulant epithelial markers
- Early & accelerated atherosclerosis
What endocrine conditions is diabetes related to?
- Cushing’s disease/syndrome
- Phaeochromoctyoma (Adrenaline tumour)
- Acromegaly
- Pregnancy
What are the risk factors to get diabetes?
- Overweight
- Hypertension
- Family history of Diabetes
- Some ethnic groups – Asian, Afro-carribean, middle eastern
- Gestational Diabetes in a previous pregnancy
What are the goal blood plasma levels before food and at bedtime?
- preprandial 4-6 mmol/L
- bedtime 6-8 mmol/L
When is insulin used to manage diabetes?
- Type 1 from diagnosis
- Type 2 with inadequate control on oral meds
What drugs might be used for prevention to reduce risk of diabetes CV symptoms?
Antiplatelet drugs
statins
antihypertensives appropriate
How should nutrition be managed in diabetes?
- less than 10% calories from saturated fat
- glycaemic index of foods compared with a standard food
- Carbohydrate counting
How should exercise be carried out to manage diabetes?
- planned activity - otherwise patient will become hypoglycaemic
- understand individual response
How should monitoring affect insulin dose?
- previous insulin dose determines plasma glucose
- learning the previous days plasma glucose can set new insulin dose for day
What differs in insulin preparation?
- time to act from injection varies -e.g. ultra long, long, short
- mixed forms possible to reduce injections
- different regimes for each individual
What are the new T1DM insulin monitoring options?
continous glucose monitoring
closed loop glucose monitoring
How is T2DM mananged through lifestyle?
- Weight loss
- Diet restriction
- avoid refined CHO
- encourage high fibre food
- reduce fat, esp. saturated
What surgery is used to manage T2DM?
gastric vertical banding – bariatric surgery
What medications are used to treat T2DM?
- Biguanides – ‘Metformin’ enhance cell insulin sensitivity
- DDP-4 inhibitors (Gliptins) – block the enzyme metabolising incretin
- GLP-1 mimetics – increase the level of incretin
- Sulphonylureas - increase pancreatic insulin secretion
When is insulin given in T2DM?
Patients unable to maintain glycaemic control with
* behavioural changes
* body weight reduction
* oral hypoglycaemic agents
- Many regimes available
- Often combined with medication * prandial or basal cover
How can acute hypoglycaemia happen in type 1 and type 2?
type 1 - mismatch between insulin and amount of sugar present
type 2 - on sulphonylurea or insulin without food!
What are the chronic diabetes complications?
- Cardiovascular risk
- infection risk
- neuropathy
What are large vessel risks of diabetes?
atheroma causing
* angina & MI, claudication, anneurysm
What are the small vessel risks of diabetes?
- poor wound healing
- easy wound infections
- RENAL DISEASE
- EYE disease
- neuropathy
What eye diseases can diabetes cause?
- Cateracts
- Maculopathy
- Proliferative retinopathy
- Glaucoma
What is maculopathy?
loss of high density cone section of retina and therefore lose detailed vision
How is diabetic retinopathy treated?
laser therapy where branches of these vessels are obliterated so no blood flows in them
What is cataracts?
lens develops small cloudy patches allowing less light into the eye causing blurry images
What does diabetic neuropathy affect?
General sensation
* ‘glove & stocking’ (loss of sensation in hands and feet)
Motor neuropathy
* weakness and wasting of muscles
Autonomic regulation
* awareness of hypoglycaemia lost
* postural reflexes
* bladder & bowel dysfunction
What are the metabolic changes associated with surgery that might affect diabetes?
- hormone changes aggravate diabetes
- epinephrine, cortisol, growth hormone
- more glucose production and less muscle uptake
- metabolic acidosis more likely
What might T2DM require periooperatively?
insulin due to poor wound healing
Why is fasting before surgery a problem in type 1 diabetics?
- need insulin to prevent ketosis
- need carbohydrate to prevent hypoglycaemia
need to be admitted to hospital prior to surgery to be established with glucose drip
What are the dental aspects of diabetes?
- Be aware of effect of dental treatment - food intake may be disrupted
- Be aware of acute emergencies (hypoglycemia)
- Be aware of diabetic complications
- IHD, dehydration, neuropathy, eyes
- Be aware of INFECTION RISK
- be aware of POOR WOUND HEALING
