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4th yr- CMS- Medicine > Diabetes and obesity > Flashcards

Diabetes and obesity Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

Name the main source of energy for the brain

A

Glucose

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2
Q

What can the brain use instead of glucose

A

Ketones

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3
Q

How much glucose does the brain use

A

80mg glucose/ minute

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4
Q

How much glucose do tissues other than the brain use

A

50mg glucose/ minute at rest

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5
Q

Can glucose diffuse accorsi cll membranes

A

no

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6
Q

How is glucose transported if it can’t diffuse across cell membranes

A

Transported via the GLUT transported

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7
Q

Describe theGLUT transporters

A

They are uniporters

they work by providing facilitated transport across cell membranes

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8
Q

Name soem different types of GLUT transporters

A
  1. glut 3

2. GLUT 4

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9
Q

Describe GLUT 3

A

It is NOT insulin dependent

Present in Neuronal cells

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10
Q

Describe GLUT 4

A

It is insulin dependent

Present in muscle and fat cells

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11
Q

What are ketones synthesised from

A

Fatty acids

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12
Q

What is the co transporter for glucose

A

Sodium

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13
Q

How are ketones transported

A

They can simply diffuse across the blood brain barrier

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14
Q

Describe how blood glucose is maintained after meal

A
  1. Eating increases blood glucose

2. Insulin stores the glucose as glycogen

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15
Q

How Is glycogen broken down at rest between meals

A

Glucagon breaks down glycogen

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16
Q

How Is glycogen broken down under stress

A

Cortisol and adrenal are related to mobilise stored glycogen

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17
Q

Insulin is the _________ pathway

A

Anabolic

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18
Q

Glucagon, cortisol, adrenaline are the _________ pathway

A

Catabolic

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19
Q

Name the key organ In charge of maintain blood glucose between meals

A

Liver

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20
Q

Describe glycogen

A

It is a polysaccharide of glucose

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21
Q

Where is glycogen found

A
  1. LIVER

2. muscles

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22
Q

Can muscle glycogen be mobilised into the blood stream

A

NO it is for muscle use only

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23
Q

What is the break down of glucose called

A

Glycolysis

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24
Q

What is the building of glucose called

A

Gluconeogenesis

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25
Q

Name a common disease affecting glucose maintenance

A

Diabetes mellitus

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26
Q

What is diabetes mellitus

A

A group of disorders with many caused which are characterised by a persistently raised blood glucose level

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27
Q

What is diabetes mellitus a result of

A
  1. A lack of insulin
  2. An inability to respond to insulin
    (can be both)
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28
Q

Name the different types of diabetes

A
  1. Type 1 diabetes mellitus
  2. Type 2 diabetes mellitus
  3. Gestational diabetes
  4. Other
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29
Q

Give examples of other types of diabetes mellitus

A
  1. Monogenic diabetes
  2. Diabetes secondary to pathological conditional such a as trauma or pancreatic surgery
  3. Drug induced
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30
Q

What is monogenic diabetes

A

Single gene defect or associated with genetic condition like Down syndrome or turners

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31
Q

Which drugs can lead to drug induced diabetes

A

long-term corticosteroid treatment

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32
Q

What does type 1 diabetes result in

A

An absolute insulin deficiency due to destriction of the beta islet cells in the pancreas

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33
Q

What causes beta islet cell destruction

A

Usually auto immune so T cells mediated destruction of the beta cells in the islets of Langherhans in the pancreas

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34
Q

Where are the beta islets cells found

A

In the pancreas

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35
Q

What type of function does the pancreas have

A

Both endocrine and exocrine

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36
Q

When does type 1 diabetes manifest

A

Usually at 90% destruction of the beta cells

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37
Q

Is diabetes type 1 fatal

A

Yes if patient doesn’t receive replacement insulin

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38
Q

What are some of the clinical signs that a patient may have type 1 diabetes

A
  1. Polyuria
  2. Polydipsia
  3. Weight loss (despite an increase in appetite)
  4. Fatigue
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39
Q

What is polyuria

A

Excess urination

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40
Q

Why is polyuria dangerous

A

Glucose in the urine causes osmoticdiuresis as urine osmotic pressure increases so kidneys cant retain the water and the patient becomes fluid depleted

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41
Q

What is polydipsia caused by

A

Fluid depltion

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42
Q

What is polydipsia

A

Extreme thirst

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43
Q

Why might a patient with type 1 diabetes lose weight without trying

A

As insulin isn’t present to do the anabolic pathway so the catabolic pathways are used to generate energy and they use fat sources

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44
Q

What can type 1 diabetics develop if their diabetes isnt controlled

A

Diabetic ketoacidosis (DKA)

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45
Q

What is Diabetic ketoacidosis (DKA)

A

Increased production of ketones which are acidic, high levels accumulate so metabolic acidosis leads to a fall in blood pH

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46
Q

Is Diabetic ketoacidosis (DKA) serious

A

YES it is a medical emergency with a 5-10% mortality

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47
Q

How do we monitor any type of diabetes

A

Monitor HbA1c blood test every 3 months to check glycated haemoglobin

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48
Q

What is the idea level of HbA1c

A

Ideally below 48mmol/mol or 6.5%

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49
Q

What is Diabetic ketoacidosis (DKA)

A

It is a complication of type 1 diabetes mellitus

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50
Q

Describe the presentation of Diabetic ketoacidosis (DKA)

A
  1. Rapid deterioration
  2. Confusion
  3. Nausea, vomiting
  4. Abdominal pain and shaking
  5. Diminshed consciousness in later stages
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51
Q

When is Diabetic ketoacidosis (DKA) more likely to happen

A
  1. Infection
  2. Missed insulin dose
  3. Surgery
  4. Binge drinking
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52
Q

What should you advise people with type one diabetes if you carry treatment on them

A

Make sure you tell patients that they still need to take their insulin and check their Especiallyif you have provided an intervention whereby they may not be able to eat or want to eat.

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53
Q

What is type 2 diabetes mellitus

A

It is a complex metabolic characterised by varying degrees to insulin resistance

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54
Q

What causes type 2 diabetes mellitus

A

dysfunction of beta cells in pancreas

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55
Q

Does DKA happen to patients with type 2 diabetes

A

NO they get Hyperosmolar hyperglycemic syndrome (HHS)

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56
Q

What is HHS

A

Hyperosmolar hyperglycemic syndrome (HHS)

57
Q

Describe Hyperosmolar hyperglycemic syndrome (HHS)

A

A very scary reaction that is difficult to manage and has a high mortality rate

58
Q

How might the beta cells of the pancreas be dysfunctional

A

They may fail to send intracellular signally pathways that normally operate one insulin has bounce to the surface of a cell

59
Q

Is the net blood glucose levels of a patient with type 2 diabetes higher or lower Ethan normal

A

Higher

60
Q

What foes dysfunction of the beta cells lead to

A

Deregulation of normal homeostatic mechanisms to produce insulin appropriately

61
Q

Initially what can happen earn the beta cells start to dysfunction

A

there may be period of excessive insulin production as more is produced in an attempt to counteract the resistance
The beta cells eventually fail due to lack of insulin production

62
Q

List some risk factors of type 2 diabetes

A
  1. Obesity
  2. Family history
  3. Ethnicity
  4. History of gastrointestinal diabetes
  5. Poor diet
  6. medications
  7. PCOS and other metabolic syndrome
63
Q

What is the Link between type 2 diabetes and obesity

A

80 times more likely to develop type 2 diabetes if you have a BMI of <23

64
Q

Which ethnicities are more likely to have type 2 diabetes

A

Asian, African and black communities are 2-4 times more likely to develop type 2 diabetes

65
Q

Describe a poor diet

A

Low fibre high GI diet

66
Q

What is gestational diabetes

A

Diabetes first recognised in pregnancies

67
Q

In whom is gestational diabetes more common in

A

Asian

68
Q

Why are the cases of gestational diabetes increasing

A

Increasing with obese mothers or pregnancy later in life

69
Q

When does gestational diabetes likely to develop

A

In the second half of pregnancy

70
Q

What is gestational diabetes associated with

A
  1. Increased size of fortis (Macrosomia)

2. Increased risk to mother eg increased risk of c section and miscarriages

71
Q

Is gestational diabetes permanent

A

Mostly resolved post partum but increases your risk by 7 to develop diabetes later in life

72
Q

What impact does having chronic diabetes have

A
  1. Microvascular disease
  2. Macrovascular diseas
  3. Metabolic disease
73
Q

Give examples of some microvascular diseases that can occur in chronic diabetes

A

1, Nephropathy

  1. retinopathy
  2. neuropathy
74
Q

What can happen in microvascular complication of diabetes

A

Capilalry endothelial becomes damaged and basement membrane thickens

75
Q

Give examples of some macrovascular diseases that can occur in chronic diabetes

A
  1. CVD,
  2. cerebrovascular disease
  3. peripheral arterial disease
76
Q

What can happen in macrovascular complication of diabetes

A

Accelarated atherosclerosis

77
Q

Give examples of some metabolic complations that can occur in chronic diabetes

A

Dyslipidaemia and ‘metabolic syndrome’

78
Q

There is a significant relationshio between diabetes and..?

A

Wound healing

79
Q

Why is immune healing affected during diabetes

A

Due to altered immune state whereby neutrophils are abnormal and don’t stick or roll well to the endothelium

80
Q

What effect can diabetes mellitus have on the oral cavity

A
  1. Periodontal
  2. Xerostomia
  3. Sialosis
  4. Fungal infections
  5. Adverse taste
81
Q

How does diabetes affect the periodontal status of the oral cavity

A
  1. Altered immune function
  2. Salivary gland function altered
  3. Increased periodontal destruction
82
Q

When does the risk of periodontal disease increase in diabetic patients

A

Increases with poor glycemic control

83
Q

How can diabetes cause Xerostomia

A

Dehydration from hyperglycaemia decreases saliva production and alters the quantity and quality of saliva

84
Q

Why do we think diabetes can change the quality and quantity of saliva

A

probably due to microvascular and autonomic neuropathy.

85
Q

What is Sialosis

A

Asymptomatic and non-inflammatory enlargement of major salivary glands

86
Q

Which fungal infections most common in the oral cavity

A

Candidiasis

87
Q

Why might diabetic patients have an adverse taste in their mouth

A

usually side-effects of medicines eg Metformin (metallic taste)

88
Q

How can we manage type 1 diabetes

A
  1. Long acting insulin

2. Short acting insulin

89
Q

Name the long acting insulin

A

Lantus

90
Q

Name the short acting insulin

A

Humalog

91
Q

How can we manage type 2 diabetes

A
  1. Weight management

2. Medication

92
Q

Give examples of some oral hypoglycaemic agents

A
    • Biguanides
  2. Gliptins
  3. Sulphonylureas
  4. α-glucosidase inhibitors
  5. Glitazones -
  6. Meglitinides
93
Q

Give an example of Biguanides

A

Metformin-

94
Q

Give an example of Gliptins

A

Sitagliptin-

95
Q

Give an example of Sulphonylureas

A

Gliclazide

96
Q

Give an example of α-glucosidase inhibitors

A

Acarbose

97
Q

Give an example of Glitazones

A

Pioglitazone

98
Q

Give an example of Meglitinides

A

Rapaglinide

99
Q

Describe Biguanides

A

They only work in the presence of insulin

100
Q

How do Biguanides work

A

They lower plasma glucose but increasing peripheral itilisation of glucose and decreasing gluconeogenesis

101
Q

How do Gliptins work

A

Inhibit enzyme DPP-4, which plays a major role in glucose metabolism. Indirectly stimulates more insulin production and reduced glucagon secretion

102
Q

What do Sulphonylureas do

A

They augment insulin secretion

103
Q

How do Sulphonylureas work

A

They endive hypoglycaemia if taken but a meal is missed

104
Q

What does alpha glucosidase do

A

It reduces carb absorption by the gut (this can lead to carb femetntion in the gut and abdominal side effects)

105
Q

What do Glitazones do

A

They enhance the effects of endogenous insulin

106
Q

What is a side effect of Glitazones

A

Fluid retention

107
Q

What are Metglitinides

A

They are glucose regulators with enhance insulin secretion

108
Q

Give example of technology we can use to manage diabetes mellitus

A
  1. Freestyle libre

2. Medtronic Insulin pump

109
Q

Describe how a freestyle libre works

A

It saves repeated CBG measurements

You how a computer over the sensor for a reading

110
Q

How do insulin pump work

A

They deliver precise basal rates of insulin via cannula

111
Q

How much insulin can an insulin pump hold

A

Holds around 300 units of insulin which can last 2-3 days

112
Q

What must you do to the cannula in an insulin pump

A

Rotate it around to avoid lipodystrophy

113
Q

How does the WHO define obesity

A

Defined as a BMI over 30

114
Q

How is BMI calculated

A

Weight(KG)/ heightxheight

115
Q

What is an ideal BMI

A

18.5-25

116
Q

When is BMI not a good tool to measure obesity

A

Problem for bodybuilders who have high muscle

117
Q

What an we use instead of BMI

A

Waist circumference

118
Q

Fundamentally what is obesity caused by

A

Consuming more calories than you use

119
Q

How many calories in a pound of weight

A

3500

120
Q

How many calories in 1g of fat

A

9 calories

121
Q

What is your basal metabolic rate

A

The amount of calories your body uses just to stay alive

122
Q

How many calories in 1g of carbohydrates

A

4 calories

123
Q

How many calories in 1g of protein

A

4 cals

124
Q

How many people were found to be overweigh

A

1.9 billion

125
Q

How many people were found to be obese

A

650 million

126
Q

How much does obesity cost to the NHS

A

£6.1 billion

127
Q

How can you manage obesity

A

Weight loss even in modest reduction

128
Q

Is obesity only caused by diet

A

no it is multifactorial

129
Q

Which three main factors affect obesity

A
  1. Lack of physical activity
  2. Dietary habits
  3. other factors eg genetics, smoking and medication
130
Q

List som health implications of obesity

A
  1. Reduced life expectancy
  2. Diabetes mellitus
  3. Hyper tension, heart failure
  4. Coronary heart disease
  5. Obstructive sleep apnoea
  6. Dyspnoea
  7. Psychosocial
  8. Osteoarthritis
  9. Stress urinary incontinence
  10. Menstrual dysfunction and reduced fertility
  11. Cancer
  12. Gastro-oesophageal reflux
  13. Non-alcoholic fatty liver disease
131
Q

By how much can obesity reduce your life expectancy

A

7-13 years

132
Q

How can obesity lead to dyspnoea

A

physical restriction of weight on the thorax limits expansion, and abdominal mass impeding the diaphragm. Also, increased oxygen demands of increased tissue mass

133
Q

How can obesity contribute to Obstructive Sleep Apnoea (OSA)

A

repeated collapse of the upper airway (in the pharynx) which results in an occluded airway for 10-15seconds (or longer)

134
Q

What can Obstructive Sleep Apnoea (OSA)lead to

A

can mean a person never feels like they have a good nights sleep and subsequently increased fatigue levels during the day

135
Q

Would we refer to patients as obese during communication

A

no use Increased body habitus

136
Q

What considerations do we need to take as a dentist if we know our paint struggles with obesity

A
  1. Access to the building
  2. Safe weight limit of dental Chris
  3. They may have excess soft tissues around the head and neck
  4. Prescribing drugs
  5. Long procedures may lead to pressure sores
  6. Increased prevalence of GORD
137
Q

What is the safe weight limit of dental chairs

A

140 kg

22 stones

138
Q

What might be more difficult to do in patients who may be obese

A

Sedation and GA

139
Q

What considerations do we need to take in patients who are obese if they have a medical emergency

A
  1. IM needles may not reach muscle
  2. Difficult to provide effective CPR
  3. Airway management and iV access can be difficult

4th yr- CMS- Medicine (14 decks)

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