Diabetes Flashcards
type I diabetes
- Formerly insulin-dependent or juvenile diabetes
- Represents 10-15% of all diabetics in the U.S.
- Onset usually below age 30, usually abrupt, and preceded by weight loss
- Severely insulin deficient and, therefore, absolutely dependent on insulin therapy
- Probably an auto-immune disorder
- Patients are usually slender or frankly underweight
- May occur in the elderly
type II diabetes
-Formerly adult onset or non-insulin dependent diabetes
-Represents 85-90% of all diabetics in U.S.
-Onset usually above age 30, but can occur at any age
-Pancreas produces insulin, but not sufficient to maintain normal glucose levels
-Most patients are also “resistant” to insulin action
-Onset often insidious and classic symptoms may be
absent
-May be controlled by diet and/or oral hypoglycemic drugs
-Usually obese, 65-75% / hypertensive/ hypercholesterolemia
-Genetic/familial component
what are the three P’s in the presentation of diabetes?
polyuria (peeing a lot), polydipsia (drinking a lot), polyphagia (eating a lot)
casual plasma glucose value that is diagnostic for diabetes
> 200 mg/dl + symptoms of diabetes
Fasting plasma glucose value that is diagnostic for diabetes
> 126 mg/dl
2-hour plasma glucose during an oral glucose tolerance test that is diagnostic for diabetes (
> 200 mg/dl
Fasting Plasma Glucose
FPG < 100 mg/dl = normal fasting glucose
FPG > 100 and 126 = diabetes mellitus
Impaired Glucose Tolerance (IGT):
2-hour post glucose load > 140 and <200 mg/dl
Glycosylated hemoglobin/Glycated hemoglobin/ HbA1C/hemoglobin A1c
- Measures percentage of glycosylated hemoglobin
- Provides estimate of approx. 90-days’ glycemic control (life cycle of an RBC)
- Normal ranges : approx. 4 to 5.6%
- DM: > 6.5%
- Desired goal for diabetics : < 7% (these patients you can treat without reservation)
3 Acute complications for diabetes
ketoacidosis
Hypoglycemic
Hyperosmolar
Diabetic pat that has 3 P’s (polyuria, polydypsia, polyphagia), dehydration, rapid deep respirations, abdominal pain, nausea and vomiting is having what high mortality rate acute diabetic complication
Diabetic ketoacidosis
Diabetic ketoacidosis usually develops in what diabetic type patient
type I
diabetic ketoacidosis
Usually develops in Type 1 patient or uncontrolled Type 2 (rare)
-Less insulin leads body to use fatty acids, ketones are byproducts of fat metabolism . “acetone breath”
-Lab – hyperglycemia, acidosis, ketosis
-Usually precipitated by stress, infection, surgery, drugs, or
poor compliance
-Signs and symptoms – 3 P’s, dehydration, rapid deep respirations, abdominal pain, nausea, and vomiting
-High mortality if not rapidly treated! Refer patient immediately if diagnosis suspected
Diabetic acute complication that usually occurs in insulin-treated patients, but may occur in patients on oral agents usually from skipping meals, vigorous exercise, or an error in insulin dosage
hypoglycemia
your diabetic patient starts: sweating, trembling, weakness, anxiety, hunger, blurry vision, confusion, seizures, come, and death
hypoglycemia
Precipitating factors: skipping meals, vigorous exercise, error in insulin dosage
hypoglycemia
txt for hypoglycemic patient
If patient is alert, give oral glucose.
l If stuporous, start IV line, obtain sample for glucose measure- ment, give IV glucose, and then send to ER
hypoglycemia overview
Usually occurs in insulin-treated patients, but may occur in patients on oral agents
l Precipitating factors: skipping meals, vigorous exercise, error in insulin dosage
l Signs and symptoms: sweating, trembling, weakness, anxiety, hunger, visual blurring; can progress to confusion, seizures, coma, and death
l Monitor vital signs – measure blood glucose with glucometer
l If patient is alert, give oral glucose.
l If stuporous, start IV line, obtain sample for glucose measure- ment, give IV glucose, and then send to ER
Hyperosmolar hyperglycemic non-ketotic coma (Hyperosmolar hyperglycemic state
Complication usually of uncontrolled type 2 DM
l Relative Insulin deficit leads to elevated serum glucose (hyperglycemia), that increases serum osmolarity.
l Hyperosmolarity in serum leads to diuresis (polyuria) that further aggravates dehydration
l Can lead to coma and is potentially fatal
l Tx with IV fluids, electrolytes, insulin
Complication usually of uncontrolled type 2 DM
l Relative Insulin deficit leads to elevated serum glucose (hyperglycemia), that increases serum osmolarity.
l Hyperosmolarity in serum leads to diuresis (polyuria) that further aggravates dehydration
l Can lead to coma and is potentially fatal
l Tx with IV fluids, electrolytes, insulin
Hyperosmolar hyperglycemic non-ketotic coma (Hyperosmolar hyperglycemic state
txt for Hyperosmolar hyperglycemic non-ketotic coma (Hyperosmolar hyperglycemic state
Tx with IV fluids, electrolytes, insulin
3 Acute complications for diabetes
ketoacidosis
Hypoglycemic
Hyperosmolar
Hyperglycemia:
Rare emergency in a dental office, takes more time to develop. Symptoms may mimic hypoglycemia. Hence glucometer is crucial in differentiating the two: small amount of extra glucose administered will have no significant effect
3 Chronic complications of Diabetes
Vascular (Macro or Micro) Neuropathy (peripheral nerve disfunction)
Mixed vascular/ neuropathic
Macrovascular Complications from diabetes
Coronary Artery Disease(heart attacks, angina) Cerebrovascular Disease (strokes, TIA’s)
Peripheral Vascular Disease (gangrene, amputations)
2 Microvascular complications of Diabetes (
Retinopathy (visual impairment) Nephropathy (end stage renal disease)
6 Goals of Diabetic Therapy
blood sugars in normal range
Avoid hypoglycemia
Achieve/maintain ideal body weight
Maintain normal growth and development in kids Allow pts to live a normal life
Prevent or postpone chronic complications
tx for type II diabetes
Diet
l Exercise
l Hypoglycemic agents
– Insulin
– Oral agents
l Careful monitoring of blood glucose levels
– Self-monitoring of blood glucose
– Hemoglobin A1c (“average” blood glucose)
measurements
l Careful observation and prompt treatment of complications
l Patient education
Very short acting Insulins (he won’t ask drug names)
Humalog (Lispro) Novalog
Apidra
different classifications of diabetes
- type 1 diabetes mellitus
- type 2 diabetes mellitus
- Impaired glucose tolerance (IGT)
- gestational diabetes
- other (“secondary”) types of diabetes
what is impaired glucose tolerance (IGT)?
- glucose levels are higher than normal but not clearly diagnostic of diabetes
- patients with IGT have increased risk of atherosclerotic complications
gestational diabetes mellitus
- about 4% of pregnancies in the US are accompanied by a degree of glucose intolerance which returns to normal after delivery
- women thus affected are at a higher risk of developing type 2 DM later in life
secondary diabetes
- endocrinopathies: hyperthryroidism,…
- chronic steroid medication use
- other medication use: thiazides…
- genetic syndrome assoication: down’s, klinefelter…
what are the different endocrinopathies that can lead to secondary diabetes?
- hyperthyroidism
- increased GH levels,
- Cushing’s syndrome
- Pheochromocytoma
what medications can contribute to development of secondary diabetes?
- thiazides
- statins
- atypical antipsychotics,
- protease inhibitors
what genetic syndromes are associated with secondary diabetes?
- Down’s
- klinefelter,
- turner,
- huntington’s…
