Diabetes for Dentists Flashcards
What symptoms would diagnose someone with diabetes
- Random plasma glucose > 11.1 mmol/l (or equal to)
* Fasting plasma glucose > 7 mmol/l (or equal to)
What are the presenting features of diabetes
• THIRST
• POLYURIA
- osmotic diuresis (excess urine)
• WEIGHT LOSS AND FATIGUE
- dehydration
- lipid and muscle loss
• PRURITIS VULVAE AND BLANANITIS
- vaginal candidiasis
• HUNGER
• BLURRED VISION
- less uptake of glucose/water into lens
• BREATH
- smell of acetone
• RESPIRATORY
- Hyperventilation
• GASTRIC
- nausea
- vomiting
- ab pain
What are the clinical features of newly diagnosed type 1 diabetes
- Short history of severe symptoms (weight loss)
* Because fat is being broken down for energy instead of glucose, ketones can be detected.
What is type 1 diabetes?
An insulin deficiency disease - autoimmune destruction of the beta cells
Treatment consists of restoring appropriate levels of insulin
What are three aims of treatment in type 1 diabetes
- Relieve symptoms and prevent ketoacidosis
- Prevent microvascular and macrovascular complications
- Avoid hypoglycaemia
Describe the microvascular complications of type 1 diabetes
- Around 30% in UK will develop diabetic nephropathy (kidney damage)
- Those with nephropathy tend to develop proliferative retinopathy and severe neuropathy, affecting quality of life
How do we treat type 1 diabetes
TO RESTORE THE PHYSIOLOGY OF THE BETA CELL
• INSULIN TREATMENT:
- twice daily mixture of short/medium acting insulin
- Basal bolus (once/twice daily medium acting insulin plus pre meal quick acting insulin)
- ABILITY TO JUDGE CARBOHYDRATE INTAKE
- AWARENESS OF BLOOD GLUCOSE LOWERING - THE EFFECT OF EXERCISE
What are the symptoms of low blood glucose
• adrenaline release
- light headed
- nausea
- heart rate increases
- shaking
- ‘frightened’
- sweating
- impaired vision
- anxious
- Important to manage insulin levels carefully (not too much)
What is the dilemma for those with type 1 diabetes?
- Setting higher glucose targets will reduce the risk of hypoglycaemia but increase the risk of diabetic complications
- Setting lower glucose targets will reduce the risk of complications but increase the risk of hypoglycaemia
Describe the pathogenesis of raised blood glucose in type 2 diabetes
- Insulin resistance which demands increased production of insulin to maintain normal glucose levels before the development of diabetes
- Progressive failure of insulin secretion
What are some the complications in type 2 diabetes
- Macrovascualr effect - MI, stoke
- Microvascular
- Nephropathy
- CHD
- Cerebrovascular disease
- Retinopathy
• Life expectancy shortened by 5-10 years
How do we treat type2 diabetes
- Ideally consists of weight loss and exercise (improves insulin resistance) which can reverse hyperglycaemia
- Medication to control BP, blood glucose and lipids
- Tight control of BP and cholesterol has a greater effect in reducing CVD - also easier to achieve than glucose control
Typical treatment pathway in Type 2 diabetes
DIET –> METFORMIN –> SULPHONYLUREA (act by stimulating release of insulin from b cells so can cause weigh gain) –> INSULIN
What is diabetic ketoacidosis and what causes it
Pt must have:
- Hyperglycaemia
- Venous bicarbonate less than 15 mmol/l
- Ketones
Causes:
- Infections
- Omission insulin
- New diagnosis
What is hyperosmolar hyperglycaemic state (HHS) / Hyperosmolar non-ketotic coma (HONK)
- Hyperglycaemia (over 50 mmol/l blood glucose)
- Hyperosmolality (osmolality usually over 350 mosmoles/l)
- Dehydration
- Risk in poorly controlled type 2 diabetes or older patients who are newly diagnosed
