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BDS2 BAMS Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

When we say diabetes what type do we usually mean

A

diabetes mellitus

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2
Q

what is the difference between diabetes mellitus and diabetes insipidus

A

mellitus = abnormality of GLUCOSE regulation

insipidus = abnormality of RENAL function (lack of ADH)

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3
Q

Why is testing for diabetes hard

A

it’s a group of symptoms, you need to know circumstances before you take a blood sample

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4
Q

How do they test for diabetes

A
  1. fasting sugar sample + test following fixed amount of sugar
  2. Random plasma glucose (RPG) on 2 occasions >11.1mmol/L is diagnostic of diabetes
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5
Q

why do complications arise in diabetes

A

prolonged time with high levels of sugar

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6
Q

What is the different diagnoses you can get when diagnosing diabetes

A
  • normal
  • impaired fasting glucose/impaired glucose tollerance
  • diabetes
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7
Q

how is diabetes mellitus classified now

A

Type 1 - insulin deficiency

Type 2 - insulin resistance (can progress to deficiency)

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8
Q

What causes type 1 diabetes

A

immune mediated pancreatic B cell destruction

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9
Q

What happens if you don’t treat type 1 diabetes

A
  • unable to manage glucose because of autioimmune disorder
  • cells not getting enough glucose as need insulin to move glucose into cells
  • metabolise ketones instead
  • get ketoacidosis
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10
Q

Why do people develop type 1 diabetes

A

genetic and environmental triggers

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11
Q

What are the differences between adult and child onset of type 1 diabetes

A

Childhood

  • more common
  • severe decompensation

Adult

  • GAD associated
  • variable period until insulin required
  • latent autoimmune diabetes in adults
  • less weight loss, less ketoacidosis
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12
Q

symptoms of type 1 diabetes

A
  • polyuria
  • polydipsia
  • tiredness
  • acute presentation
  • hyperglycaemia with diabetic symptoms
  • ketoacidosis
  • usually require insulin from diagnosis
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13
Q

is type 1 or 2 more common

A

2 (90% of all cases)

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14
Q

what is strongly associated with type 2 diabetes

A

obesity and inactivity

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15
Q

Do type 2 patients get ketoacidosis

A

rarely

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16
Q

what is the family concordance like in type 2 diabetes

A

strong (100% in identical twins)

17
Q

How can type 2 diabetes arrise

A
  • defect in insulin resistance
  • defect in insulin secretion
  • basal hepatic glucose output increased
  • insulin simulated muscle glucose uptake is reduced
18
Q

What are the effects of type 2 diabetes

A
  • impaired glucose tolerance
  • hyperinsulinaemia
  • hypertension
  • obesity with abdominal distribution
  • dyslipidaemia
  • procoagulant epithelial markers
  • early and accelerated atherosclerosis
19
Q

What do type 2 diabetic people usually present with

A
  • gradual onset
  • retinal damage
  • polyuria, polydiipsia, tiredness
  • unusual infections
  • diabetic complications (CVS)
20
Q

What can protect from and even reverse type 2 diabetes

A

strict diet and exercise

21
Q

Compare features of type 1 and type 2 diabetes

A

Type 1

  • younger
  • thin
  • ? family history of type 1
  • ? family history of autoimmune disease
  • diabetic symptoms
  • easily get ketosis

Type 2

  • older
  • obese
  • strong family history
  • diabetic symptoms?
  • present with complications
  • rarely get ketosis
22
Q

How is diabetes managed

A
  • education
  • targets
  • management tools (drugs/insulin - basal-bolus v split-mixed control)
  • nutrition
  • exercise
  • monitoring
23
Q

Describe the differences between 2 options of insulin regimes

A
  • twice-daily soluble and isophane insulin regime (Short and medium acting taken together which over the day will keep insluin where you need it to be. Can only eat just after having injection)
  • basal-bolus (slow acting plus short acting ones depending on what your day is going to look like - gives more flexibility for patient)
24
Q

Type 1 management

A

insulin subcutaneously is best (can be inhaled too)

- different regimes for each individual

25
Q

Type 2 management

A
  • weight loss
  • diet restriction
  • Diet pills
  • surgery
  • oral hypoglycaemic agents
26
Q

What are the different oral hypoglycaemic agents

A

Insulin secretagogues
- sulphonylureas (increase pancreatic insulin secretion)

Insulin sensitisers
- biguanides (enhance cell insulin sensitivity, reduce hepatic gluconeogenesis, preferred in the obese)

27
Q

When would you give insulin to a type 2 diabetic

A

when they’re unable to maintain glycaemic control with:

  • behavioural changes
  • body weight reduction
  • oral hypoglycaemic agents
28
Q

Complications of diabetes (acute and chronic)

A

Acute - hypoglycaemia

  • type 1
  • type 2 or sulphonylurea/ insulin
  • insulin/drug without food

Chronic

  • CVS
  • infection risk
  • neuropathy
29
Q

Complications of diabetes (small and large vessel)

A

Large vessel

  • angina/MI
  • claudication
  • anneurysm

Small vessel disease

  • poor wound healing (foot ulcers)
  • easy wound infections
  • renal disease
  • eye disease (cateracts, proliferative retinopathy)
  • neuropathy (general sensation, motor neuropathy- wasting of muscles, autonomic regulation e.g. bladder and bowel dysfunction)
30
Q

why might surgery be a problem for diabetics

A
  1. fasting is a problem for type 1 diabetics
    - need insulin to prevent ketosis
    - need carbohydrate to prevent hypoglycaemia
  2. metabolic changes associated with surgery
  3. increased insulin requirements in type 1
  4. type 2 may require insulin cover perioperatively
31
Q

What are the dental aspects of diabetes

A
  • be aware of effect of dental treatment
  • be aware of acute emergencies
  • be aware of diabetic complicatoins
  • be aware of infection risk
  • be aware of poor wound healing

BDS2 BAMS Endocrinology (3 decks)

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