DIabetes

Question 1

What is Diabetes Mellitus?

Answer 1

Raised blood glucose level due to problem with insulin

Question 2

What is type 1 DM?

Answer 2

Insulin dependent - body doesn’t make insulin

Question 3

What is type 2 DM?

Answer 3

Non-insulin-dependent - can’t react to insulin

Question 4

What cells make insulin?

Answer 4

Beta cells in islet of Langerhans

Question 5

Symptoms of type 1 DM?

Answer 5

Polyuria (increased urine)
Polydipsia (excessive thirst)
Weight loss
Blurred vision (due to increased glucose and dehydration = change in osmotic pressure)

Question 6

Symptoms of type 2 DM?

Answer 6

May be asymptomatic
May be same at type 1
May be susceptible to infections

Question 7

What type of test can diagnose type 2 DM?

Answer 7

75 gram oral glucose tolerance test

Question 8

What is glycated haemoglobin?

Answer 8

Glucose sticks to haemoglobin

Question 9

How does a person with diabetes differ in terms of glycated haemoglobin levels?

Answer 9

Higher than normal

Question 10

Aims of diabetes treatment?

Answer 10

Control symptoms
Prevent complications
Lead a normal life

Question 11

How is type 1 DM controlled?

Answer 11

Insulin

Question 12

How is type 2 DM controlled?

Answer 12

Can be diet alone

or diet and drugs

Question 13

What raises glucose?

Answer 13

Food
Glucagon, adrenaline, cortisol
Illness/stress

Question 14

What lowers glucose?

Answer 14

Starvation
Insulin
Exercise

Question 15

List the mechanism of action of 3 different hypoglycaemic drugs

Answer 15

Drugs that stimulate insulin production
Increase the action of insulin
Increase glycosuria

Question 16

What are the 3 types of insulin given to diabetic patients?

Answer 16

Short acting
Intermediate/long acting
Biphasic

Question 17

How can diabetes complications be categorised?

Answer 17

Acute and chronic

Question 18

List 3 acute complications?

Answer 18

Ketoacidosis (type 1)
Hyperosmolar hyperglycaemic state (type 2)
Hypoglycaemia

Question 19

List 4 chronic compliations?

Answer 19

Microvascular e.g. retinopathy, neuropathy, nephropathy
Macrovascular e.g. peripheral, coronary, cerebral
Neuropathy
Foot problems

Question 20

How can long term complications be prevented?

Answer 20

Good glucose control
Control blood pressure
Avoidance of other risk factors e.g. smoking, obesity
Early detection - screening

Question 21

Advantages of good glucose control?

Answer 21

Reduces complication e.g. microvascular, amputations, heart failure, cataracts

Question 22

Disadvantages of good glucose control?

Answer 22

Can cause hypoglycaemia if controlled to tightly

Question 23

How is retinopathy treated?

Answer 23

Laser photocoagulation

Question 24

How is nephropathy treated?

Answer 24

ACE inhibition, dialysis, transplantation

Question 25

Symptoms of early hypoglycaemia?

Answer 25

``` Tremor Anxiety Palpitations Hunger Dry mouth ```

Question 26

Symptoms of established hypoglycaemia?

Answer 26

``` Confusion/aggression Slurred speech Inco-ordination Coma Convulsions Death ```

Question 27

What causes hypoglycaemia?

Answer 27

Treatment of DM (insulin and other hypoglycaemic drugs)

Question 28

What causes the early symptoms of hypoglycaemia?

Answer 28

Increase production of adrenaline - adrenergic

Question 29

Why doesn't everyone get the warning symptoms of hypoglyaemia?

Answer 29

Long term effects of DM = neuropathy | This can damage sympathetic NS and means adrenaline is secreted = no warning signs

Question 30

How is hypoglycaemia treated?

Answer 30

Oral glucose Glucose tablets Glucose gel (squeeze into mouth) Injections

Question 31

Effect of glucagon?

Answer 31

Increases blood glucose

Question 32

How does type 1 DM cause ketoacidosis?

Answer 32

Hyperglycaemia causes dehydration (increased urine production) Loss of NA in urine Loss of K from cell and then in urine Accumulation of ketone bodies

Question 33

Clinical features of ketoacidosis?

Answer 33

Thirst, polyuria Dehydration - dry mouth Confusion/drowsiness

Question 34

Prevention of diabetic ketoacidosis?

Answer 34

Never omit insulin in type 1 DM even if they haven't had any food Educate the patient

Question 35

What is hyperosmolar ketotic coma?

Answer 35

Similar to ketoacidosis but without the keto acids

Question 36

What do dental professionals need to know about a patients diabetes?

Answer 36

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