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4th Yr - CMS 1 > Diabetes and obesity > Flashcards

Diabetes and obesity Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

how much glucose does the brain use ?

A

80mg glucose/ min

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2
Q

how much glucose do other tissues need?

A

50 mg glucose/ min at rest
- will increase if ur doing exercise or stress

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3
Q

how does glucose move into cells

A

diffuse or by transporters GLUT across membranes

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4
Q

which GLUT transporters are need in the brain ? and are not insulin dependent ?

A

GLUT 1 and 3

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5
Q

what GLUT transporter is needed in muscle and fat cells in peripheral tissues ? an is insulin dependant?

A

GLUT 4

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6
Q

when are fatty cells used for brain function ?

A

ketones are synthesised from fatty acids when glucose isn’t easily accessible

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7
Q

when are cortisol and adrenaline used in the transport of glucose?

A

under times of physical and mental stress

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8
Q

where do break down glycogen into glucose at rest ?

A

liver

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9
Q

what happens if we don’t have enough glycogen stores or we need glucose extremely quickly ?

A

use fatty acids > triglycerides > glycerol > liver glucose
- done in liver

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10
Q

what is diabetes mellitus?

A
  • chronic condition
  • raised blood glucose
  • difficulty in converting glucose or food into energy source the body requires
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11
Q

what is diabetes mellitus a result of?

A
  • lack of insulin
  • inability to respond to insulin
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12
Q

what is type 1 diabetes?

A
  • autoimmune - T cell mediated where body attack beta cells in island of langerhans in pancreas
  • destrcuction of these cells leads to lack of insulin
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13
Q

what is type 2 diabetes?

A

inability to produce enough volume of insulin
the insulin that is produced is resisted from the body leading to high vol of glucose
complex metabolic disorder

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14
Q

what is gestational diabetes?

A

affects pregnant women
high glucose levels during pregnancy
pts require close monitoring with consultant obstetrician with additional scans and delivery complications

  • this condition resolves after delivering baby
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15
Q

what is diabetes incipitous ?

A

imbalance in antidiuretic hormone has no link to diabetes mellitus and insulin levels

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16
Q

when is type 1 diabetes diagnosed ?

A

at childhood early adolescents or birth

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17
Q

why do some ppl get diagnosed later?

A

disease typically manifests when 80-90% of b cells are destroyed - body unable to use glucose as its main energy source over a prolonged period of time

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18
Q

what is diabetic ketoacidosis ?

A

liver starts to break down fats as its main energy source= increased levels of ketones which increases acidity in blood = brain requires the right PH if not then it will lead to pts feeling confused, disoreineteated, nausea, vomiting, abdominal pain and even loss of consciousness

  • DKA = med emergency with 5-10% mortality and fatal if left untreated
  • DKA is a complication of type 1
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19
Q

what are some symptoms of poorly controlled type 1 diabetes?

A

polyuria
polydipsia
weight loss
fatigue

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20
Q

how do we monitor type 1 ?

A

HbA1c blood test every 3 month to check glycated haemoglobin
- ideally above 48mmol/mol or 6.5%

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21
Q

when can trigger DKA?

A

infections - eg. dental infection aren’t well enough to eat don’t take insulin ketones rise

missed insulin doses

surgery

binge drinking

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22
Q

what is hyperosmolar hyperglycaemic state HSS ?

A

occurs in type2 and has similar presentation to DKA

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23
Q

what are some risk facts of type 2 ?

A

obesity - 8 times likely
family history - 2-4 times likely
ethnicity - asian African carribean
hx of gestational diabetes
poor diet

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24
Q

how many cases of type 2 remain undiagnosed?

A

50%

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25
Q

why do some type 2 pts experience hypoglycaemia?

A

medication
not eating or eating at right time

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26
Q

what are the signs and symptoms of hypoglycaemia

A

cold sweats
palpitations
trembling
excessive hunger
weakness
drowsiness
fits

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27
Q

what conditions can hypoglycaemia symptoms be similar to ?

A

anxiety and sedation

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28
Q

when does gestational diabetes occur?

A

in pregnancy usually during second half

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29
Q

who is at higher risk ?

A

asians and caucasians
obese mothers or pregnancy later in life

30
Q

what is pathology of gestational diabetes ?

A

insulin resistance

31
Q

what are some risks to the mother?

A

pre eclampsia and increased risk of emergency c section

32
Q

when does gestational diabetes resolve ?

A

post party but 7x more likely to develop diabetes later in life

33
Q

list the diseases that re impacts of chronic illnesses

A

microvascular
macrovascular
mixed complications
metabolic complications
increased infection complications

34
Q

list some microvascular diseases

A
  • Capillary endothelial damage and basement membrane thickening
  • Nephropathy, retinopathy and neuropathy
35
Q

list some microvascular diseases

A
  • Accelarated atherosclerosis
  • CVD, cerebrovascular disease and peripheral arterial disease
36
Q

list some mixed complications

A

erectile dysfunction
diabetic foot changes

37
Q

list some metabolic complications

A

-DKA is the main metabolic issue – hyperglycaemia, acidosis and ketonemia
- Dyslipidaemia and ‘metabolic syndrome’ (DM, HT, Obesity).

38
Q

what are some increases infection complications

A

skin oral vaginal nail bacteria and candida

39
Q

What contributes to the altered immune state in diabetes affecting wound healing?

A

abnormalities in neutrophils

40
Q

How do high glucose levels in diabetes impact wound healing?

A

High glucose levels in diabetes create an environment that is ideal for secondary bacterial and fungal infections, further complicating the wound healing process.

41
Q

How does diabetes impact periodontal health?

A

Diabetes can affect periodontal health through altered immune function, salivary gland function, and increased periodontal destruction. The risk increases with poor glycemic control

42
Q

What is xerostomia, and how is it related to diabetes?

A

a condition characterized by decreased saliva production. In diabetes, hyperglycemia-induced dehydration can contribute to xerostomia, and microvascular and autonomic neuropathy may alter the quantity and quality of saliva

43
Q

What is sialosis, and how does it manifest in individuals with diabetes?

A

Sialosis is the asymptomatic and non-inflammatory enlargement of major salivary glands. It can occur in individuals with diabetes.

hard to manage
cosmetic concern

44
Q

What types of fungal infections are commonly associated with diabetes in the oral cavity?

A

mostly candidiasis, are commonly associated with diabetes. In rare cases, more severe infections such as mucomycosis or aspergillosis may occur

45
Q

How can diabetes-related medications contribute to adverse taste?

A

adverse taste, such as a metallic taste, can be a side effect of diabetes-related medications, for example, Metformin

46
Q

how do we treat type 1 ?

A

There are three types of insulin
- Short-acting (e.g., Humalog)
- Long-acting (e.g., Lantus)
- Mixture of rapid and intermediate-acting (e.g., NovoMix® 30, which contains 30% rapid and 70% intermediate insulin).

47
Q

how do we treat type 2? list all the meds

A
48
Q

What is the mechanism of action of Metformin, a biguanide?

A

works in the presence of insulin. It lowers plasma glucose levels by increasing peripheral utilization of glucose and decreasing gluconeogenesis in liver

49
Q

What is the role of DPP-4 inhibitors like Sitagliptin in diabetes management?

A

DPP-4 inhibitors, inhibit the enzyme DPP-4, playing a major role in glucose metabolism. This inhibition indirectly stimulates more insulin production and reduces glucagon secretion.

50
Q

How do Sulphonylureas, like Gliclazide, contribute to diabetes management?

A

Sulphonylureas, augment insulin secretion. However, they can induce hypoglycemia if taken and a meal is missed

51
Q

What is the mechanism of action of α-glucosidase inhibitors, exemplified by Acarbose?

A

α-glucosidase inhibitors, like Acarbose, reduce carbohydrate absorption by the gut, leading to a decrease in postprandial glucose levels. However, they can cause abdominal side effects.

52
Q

How do Glitazones, such as Pioglitazone, enhance the effects of insulin?

A

Glitazones enhance the effects of endogenous insulin. However, caution is needed in heart failure or renal impairment due to potential fluid retention.

53
Q

What is the function of Meglitinides, exemplified by Rapaglinide, in glucose regulation?

A

Meglitinides, including Rapaglinide, enhance insulin secretion, providing a rapid onset of action with a short duration.

54
Q

What is the mechanism of action of GLP-1 agonists, like Dulaglutide (Trulicity)

A

GLP-1 agonists, such as Dulaglutide, mimic the action of glucagon-like peptide-1, promoting insulin secretion, inhibiting glucagon release, and slowing gastric emptying.

not insulin but given in injection form

55
Q

What is the purpose of the Libre sensor in diabetes management?

A

The Libre sensor is used to save repeated continuous blood glucose (CBG) measurements. It allows users to hold a computer over the sensor for a reading, and there are also apps available for phones

56
Q

How does an insulin pump contribute to diabetes management?

A

An insulin pump delivers precise basal rates of insulin via a cannula. It also allows additional boluses to be delivered to match carbohydrate intake. Insulin pumps typically hold around 300 units of insulin, lasting on average 2-3 days. The cannula site is rotated to avoid lipodystrophy.

57
Q

Obesity definition according to WHO

A

Body Mass Index (BMI) over 30
Obesity is described as “abnormal or excessive fat accumulation that presents a risk to health

58
Q

cause of obesity?

A

consuming excess calories and/or physical inactivity

59
Q

management of obesity?

A

weight loss, even through modest reductions, as a primary approach

60
Q

what is obese category 2

A

35-39.9

61
Q

what is obese category 1

A

BMI of 30-34.9

62
Q

what is obese category 3

A

greater than 40

63
Q

what are the other measurements for obesity ?

A

waist circumference

64
Q

how many calories do we need to gain a pound?

A

3500

65
Q

How has a lack of physical activity contributed to the rise in obesity?

A

Lack of physical activity has contributed to obesity as people have become more sedentary in their day-to-day lives, relying more on vehicles for transportation and engaging in less labor-intensive work. Additionally, the prevalence of TV and computers as primary sources of entertainment has reduced overall physical activity.

66
Q

What changes in dietary habits have contributed to obesity

A

Changes in dietary habits contributing to obesity include a greater availability of calorie-dense foods at a lower cost, a shift toward prepared/processed foods from supermarkets, and complex issues surrounding food and social dynamics

67
Q

Besides lack of physical activity and dietary habits, what are some other factors contributing to obesity?

A

her contributing factors to obesity include genetics (although rarely causative), former smokers being more likely to become obese than those who never smoked, and the use of certain medications such as anticonvulsants, antidepressants, corticosteroids, and some diabetes medications.

68
Q

What general health considerations should be established for individuals with obesity in dentistry?

A

assessing their overall health status and identifying any underlying medical conditions that may impact dental treatment.

69
Q

list all the implications of obesity

A
  1. Reduced life expectancy
  2. Diabetes Mellitus
  3. Hypertension, Heart Failure and Stroke
  4. Coronary Heart Disease
  5. Immune / Haematological function
  6. Obstructive Sleep Apnoea (OSA)
  7. Psychosocial
  8. Osteoarthritis
  9. Stress urinary incontinence
  10. Menstrual / erectile dysfunction and reduced fertility
  11. Cancer
  12. Gastro-oesophageal reflux
  13. Non-alcoholic fatty liver disease
  14. Gallbladder disease
70
Q

What specific considerations in dentistry are related to obesity?

A
  • Access to the building for individuals with limited mobility ie. lifts in hospitals
  • Ensuring that dental chairs have a safe weight limit (usually 22 stone/140 kg)
  • Managing excess soft tissue around the head and neck - parotid glands, lymph nodes
  • Adjusting drug prescriptions based on body weight
  • Being mindful of the risk of pressure sores during long dental procedures
  • Recognizing the increased prevalence of Gastroesophageal Reflux Disease (GORD).
71
Q

What challenges might dentists face in sedation and general anesthesia procedures for individuals with obesity?

A

Dentists may face challenges in sedation and general anesthesia procedures for individuals with obesity, including difficulties in achieving effective sedation and anesthesia due to altered drug pharmacokinetics and potential airway management challenges.

72
Q

What issues might arise in medical emergencies for individuals with obesity in a dental setting?

A

In medical emergencies for individuals with obesity in a dental setting:
- Administering intramuscular (IM) injections may be challenging due to increased adipose tissue
- Providing effective cardiopulmonary resuscitation (CPR) may be difficult due to moving the patient and challenges in identifying anatomical landmarks
- Managing the airway and obtaining intravenous (IV) access can be more challenging.

4th Yr - CMS 1 (27 decks)

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