DIabetes Flashcards
What is Diabetes Mellitus?
Raised blood glucose level due to problem with insulin
What is type 1 DM?
Insulin dependent - body doesn’t make insulin
What is type 2 DM?
Non-insulin-dependent - can’t react to insulin
What cells make insulin?
Beta cells in islet of Langerhans
Symptoms of type 1 DM?
Polyuria (increased urine)
Polydipsia (excessive thirst)
Weight loss
Blurred vision (due to increased glucose and dehydration = change in osmotic pressure)
Symptoms of type 2 DM?
May be asymptomatic
May be same at type 1
May be susceptible to infections
What type of test can diagnose type 2 DM?
75 gram oral glucose tolerance test
What is glycated haemoglobin?
Glucose sticks to haemoglobin
How does a person with diabetes differ in terms of glycated haemoglobin levels?
Higher than normal
Aims of diabetes treatment?
Control symptoms
Prevent complications
Lead a normal life
How is type 1 DM controlled?
Insulin
How is type 2 DM controlled?
Can be diet alone
or diet and drugs
What raises glucose?
Food
Glucagon, adrenaline, cortisol
Illness/stress
What lowers glucose?
Starvation
Insulin
Exercise
List the mechanism of action of 3 different hypoglycaemic drugs
Drugs that stimulate insulin production
Increase the action of insulin
Increase glycosuria
What are the 3 types of insulin given to diabetic patients?
Short acting
Intermediate/long acting
Biphasic
How can diabetes complications be categorised?
Acute and chronic
List 3 acute complications?
Ketoacidosis (type 1)
Hyperosmolar hyperglycaemic state (type 2)
Hypoglycaemia
List 4 chronic compliations?
Microvascular e.g. retinopathy, neuropathy, nephropathy
Macrovascular e.g. peripheral, coronary, cerebral
Neuropathy
Foot problems
How can long term complications be prevented?
Good glucose control
Control blood pressure
Avoidance of other risk factors e.g. smoking, obesity
Early detection - screening
Advantages of good glucose control?
Reduces complication e.g. microvascular, amputations, heart failure, cataracts
Disadvantages of good glucose control?
Can cause hypoglycaemia if controlled to tightly
How is retinopathy treated?
Laser photocoagulation
How is nephropathy treated?
ACE inhibition, dialysis, transplantation
Symptoms of early hypoglycaemia?
Tremor Anxiety Palpitations Hunger Dry mouth
Symptoms of established hypoglycaemia?
Confusion/aggression Slurred speech Inco-ordination Coma Convulsions Death
What causes hypoglycaemia?
Treatment of DM (insulin and other hypoglycaemic drugs)
What causes the early symptoms of hypoglycaemia?
Increase production of adrenaline - adrenergic
Why doesn’t everyone get the warning symptoms of hypoglyaemia?
Long term effects of DM = neuropathy
This can damage sympathetic NS and means adrenaline is secreted = no warning signs
How is hypoglycaemia treated?
Oral glucose
Glucose tablets
Glucose gel (squeeze into mouth)
Injections
Effect of glucagon?
Increases blood glucose
How does type 1 DM cause ketoacidosis?
Hyperglycaemia causes dehydration (increased urine production)
Loss of NA in urine
Loss of K from cell and then in urine
Accumulation of ketone bodies
Clinical features of ketoacidosis?
Thirst, polyuria
Dehydration - dry mouth
Confusion/drowsiness
Prevention of diabetic ketoacidosis?
Never omit insulin in type 1 DM even if they haven’t had any food
Educate the patient
What is hyperosmolar ketotic coma?
Similar to ketoacidosis but without the keto acids
What do dental professionals need to know about a patients diabetes?
Check control and usual treatments
DO they have any complications
See them first thing in the morning to minimise disruption
Check glucose before and after
