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BDS 2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the two types of diabetes?

A
  • INSULIN DEFICIENCY!! Diabetes Mellitus (abnormality of glucose regulation)
  • INSULIN RESISTANCE!! Diabetes Insipidus (abnormality of renal function`)
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2
Q

What is the normal and diabetic levels for after a glucose tolerance test?

A

FPG- normal- under 6.1
diabetic over 7

2 hour plasma glucose- under 7.8 normal and diabetes over 11.1.

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3
Q

What is type 1 diabetes?

A

It is immune mediated pancreatic B cell destruction.

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4
Q

What are the circulating antibodies in type 1 diabetes?

A

GAD
ICA
IAA

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5
Q

What are the consequences of having untreated/uncontrolled diabetes type 1?

A

Hyperglycaemia and Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body.

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6
Q

What gene is most closely associated with type 1 diabetes?

A

HLA gene: encoding DR and DQ.

GENETIC AND ENVIRONMENTAL COMPONENT.

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7
Q

What is adult onset type 1 diabetes?

A

Latent autoimmune diabetes in adults over 25 years of age. Less weight loss, less ketoacidosis. “Non obese type 2”.

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8
Q

What is adult onset type 1 diabetes?

A

Latent autoimmune diabetes in adults over 25 years of age. Less weight loss, less ketoacidosis. “Non obese type 2”. GAD associated.

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9
Q

What are the symptoms and presentation of type 1 diabetes?

A

S- polyuria, polydipsia and tiredness.

P- hyperglycaemia with diabetic symptoms and ketoacidosis.

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10
Q

How do you diagnose type 2 diabetes?

A

By excluding out type 1. Most common form of diabetes and is strongly associated with obesity and inactivity. Usually in patients over 40 years of age. It is completely genetic.

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11
Q

What effects does type 2 diabetes have on the body?

A
  1. It is a defect in insulin resistance- elevated insulin levels.
  2. Defect in insulin secretion- B cell response to hyperglycaemia is inadequate.
  3. Insulin stimulated muscle glucose uptake is reduced.
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12
Q

What are the metabolic effects of type 2 diabetes?

A

 Impaired glucose tolerance
 Hyperinsulinaemia
 Hypertension
 Obesity with abdominal distribution  Dyslipidaemia (High VLDL, Low HDL)
 Procoagulant epithelial markers
 Early & accelerated atherosclerosis.

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13
Q

What is IGT?

A

Impaired glucose tolerance means that blood glucose is raised beyond normal levels, but not high enough to warrant a diabetes diagnosis. With impaired glucose tolerance you face a much greater risk of developing diabetes and cardiovascular disease.

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14
Q

How does type two diabetes usually present?

A

Polyuria, polydipsia and tiredness. Unusual infections present . The ability to secrete insulin falls with time and there is often retinal damage with diagnosis. Usually IGT for some time.

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15
Q

Compare type 1 and type 2 diabetes.

A

Type 1- usually thin, young people and they have a small family history of type 1 and autoimmune diseases. They have diabetic symptoms and easily get ketosis.

Type 2- Older, obese patients and they have a strong family history. Gradual onset of diabetic symptoms and they rarely get ketosis.

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16
Q

How do you manage diabetes?

A

Educate the patient- about diabetes, managing diabetes.

  • Planned exercise activity- need to know limits as insulin activity decreases during exercise.
  • Less than 10% of calories from saturated fat.
17
Q

What are the targets for preprandial and bedtime glucose levels?

A

Preprandial- 4-6mmol/L

Bedtime- 6-8mmol/L

18
Q

What is basal-bolus control and split-mixed control?

A

A basal-bolus insulin regimen involves a person with diabetes taking both basal and bolus insulin throughout the day. It offers people a way to control their blood sugar levels without needing to eat meals at specific times each day and helps them achieve similar blood sugar levels to people who do not have diabetes.

SPLIT MIXED- Most pediatric patients with T1D were started on a “2-shot split-mix” regimen, which combined short- and long-acting insulins( in a single injection given twice daily at a total daily dose of approximately 1 unit/kg.

19
Q

What is the glycemic index?

A

The glycaemic index (GI) tells us whether a carbohydrate-containing food raises blood glucose levels quickly, moderately or slowly. …
The GI index runs from 0 to 100 and usually uses pure glucose, which has a GI of around 100, as the reference.

20
Q

What is the sliding scale approach?

A

The most common method to treat hospitalised people with diabetes is sliding scale insulin therapy . The term ‘sliding scale’ refers to the increasing administration of the pre-meal insulin dose based on the blood sugar level before the meal.

21
Q

How to manage type 2 diabetes?

A
  • Weight loss
  • Diet restriction (encourage high fibre foods and reduce fat intake specially saturated fats)
  • Diet pills (orlistat and sibutarmine)
  • Surgery- gastric bypass.
22
Q

WHAT ORAL HYPOGLYCAEMIC AGENTS ARE TAKEN FOR TYPE 2 DIABETES?

A

Insulin secretagogues- SULPHONLYLUREAS (increase pancreatic insulin secretion and can cause hypoglycaemia)- gliclazide, tolbutamide, glibenclamide.

Insulin sensitisers- biguanide-metformin and thiazolidineidones- rosiglitazone.

23
Q

What do sulphonylureas do for type 2 diabetes and what is a side effect?

A

Insulin secretagogues- SULPHONLYLUREAS (increase pancreatic insulin secretion and can cause hypoglycaemia)- gliclazide, tolbutamide, glibenclamide.

24
Q

What do biguanide do for type 2 diabetes and name some examples.

A

They enhance insulin sensitivity and are preferred in obese patients. They reduce hepatic glyconeogenesis.

25
Q

Gluconeogenesis?

A

Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates.

26
Q

When is insulin used in type 2 diabetics?

A

When patients are unable to maintain their glycemic control with behavioural changes, body weight reduction and oral hypoglycaemic agents. Often have to take metformin along with insulin and have prandial or basal cover.

27
Q

What does DIGAMI stand for and what does the study show?

A

Diabetes and insulin glucose infusion in acute myocardial infarction patients. The study shows that there are benefits in insulin treatment after a MI in type 2 diabetics.

28
Q

What group of diabetics are at the highest risk for severe hypoglycaemia?

A

Insulin treated patients with type 1 diabetes.

29
Q

What are the symptoms of acute hypoglycaemia?

A

Hypoglycemia, also known as low blood sugar, is a fall in blood sugar to levels below normal. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures or death. A feeling of hunger, sweating, shakiness and weakness may also be present.

30
Q

List some diabetic complications?

A

Large vessel- angina, MI, claudication and aneurysm.

Small vessel- poor wound healing, easy would infections, renal disease!!!!!!, eye disease (cataract, maculopathy and proliferate retinopathy) and neuropathy.

31
Q

What is cataract?

Explain cataract surgery.

A

A clouded lens which allows less light to pass into the eye, images are blurry.

-Incision, iridectomy, removal of lens and insertion of the replacement lens.

32
Q

Diabetic neuropathy?

A

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. … Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your legs and feet to problems with your digestive system, urinary tract, blood vessels and heart.

General sensation- “glove and stocking”.
Weakness and wasting of muscles.
Autonomic regulation- awareness of hypoglycaemia lost, bladder and bowel dysfunction, postural reflexes.

33
Q

What is the difference between ketosis and ketoacidosis?

A

Ketosis and ketoacidosis both involve the production of ketones in the body. However, while ketosis is generally safe, ketoacidosis can be life-threatening. Nutritional ketosis occurs when the body starts burning fat instead of glucose

34
Q

What are the metabolic changes associated with surgery in diabetics?

A
  • hormone changes aggravate diabetes
  • more glucose production and less muscle uptake
  • metabolic acidosis more likely
35
Q

What are the metabolic changes associated with surgery in diabetics?

A
  • hormone changes aggravate diabetes
  • more glucose production and less muscle uptake
  • metabolic acidosis more likely
  • type 2 may require insulin cover perioperatively
  • increased insulin requirements in type 1.
36
Q

What are the dental aspects of diabetes?

A 
 Be aware of effect of dental treatment
 food intake may be disrupted
 Be aware of acute emergencies
 Be aware of diabetic complications  IHD, dehydration, neuropathy, eyes
 Be aware of INFECTION RISK
 be aware of POOR WOUND HEALING.

BDS 2 (19 decks)

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