Diabetes Management

Question 1

What are the targets for blood sugar

Answer 1

Preprandial - 4 to 6 mol/L

Bedtime - 6 to 8 mol/L

Question 2

Why is the blood sugar target higher at bedtime

Answer 2

To reduce the risk of hypoglycaemia

Question 3

When is insulin used in diabetes management

Answer 3

Type 1 from diagnosis

Type 2 with inadequate control of oral meds

Question 4

How is insulin injection carried out

Answer 4

Subcutaneous injection into any area of the body
Injection site often rotated as it leads to fat atrophy
Needle and syringe most often used
Insulin pen where patient can dial number of units required

Question 5

How can diabetes management be broken down

Answer 5

Structured education appropriate to patients needs
Healthy living advice
Blood glucose management
Consider prevention to reduce risk - anti platelet drugs, statins and hypertensives

Question 6

How is type 1 diabetes nutrition managed

Answer 6

Less than 10% of calories from saturated fats
Glycemic index allows patient to compare foods and maintain the same overall sugar level
Carbohydrate counting

Question 7

How should exercise be carried out in type 1 diabetes

Answer 7

Planned activity as it will lower blood sugar which could lead to hypoglycaemia

Question 8

What are the monitoring options for type 1 diabetes

Answer 8

Continuous glucose monitoring - device attaches to skin and needle monitored tissue fluid glucose levels subcutaneously
Closed loop glucose monitoring - monitors attach to an insulin pump which will change the amount of insulin delivered to the body in a continuous way

Question 9

How can type 2 diabetes management be broken down

Answer 9

Lifestyle
Medication
Surgery

Question 10

How can lifestyle manage type 2 diabetes

Answer 10

Weight loss

Diet restriction - avoid refined carbs, encourage high fibre food, reduce fats

Question 11

What is the first line of drugs for type 2 diabetes and what do they do

Answer 11

Biguanides - metformin
Enhances cell insulin sensitivity and reduces hepatic gluconeogenesis
Preferred in the obese

Question 12

What other drugs can be used to treat type 2 diabetes and what do they do

Answer 12

DDP-4 inhibitors - block the enzyme metabolising incretin
GLP-1 mimetics - increase the level of incretin
Sulphonylureas - increase pancreatic insulin secretion

Question 13

What is the problem with sulphonylureas

Answer 13

Can cause hypoglycaemia

Question 14

What are incretins and how can drugs to do with incretins help manage type 2 diabetes

Answer 14

Incretins are released from the stomach in response to sugar absorption and stimulate insulin release
If the enzyme metabolising them is blocked, they will stay in circulation for longer and improve the response of the body to glucose in producing insulin

Question 15

What are the acute complications of diabetes

Answer 15

Hypoglycaemia
Will happen in type 1 if patient injects insulin but forgets to have an adequate meal
Type 2 patients can become hypoglycaemic if they have injected insulin or are on sulphonylureas

Question 16

What are the chronic complications of diabetes

Answer 16

Cardiovascular risk due to macrovascular changes to blood vessels with increased atherosclerosis
Microvascular consequences lead to infection risk and neuropathy

Question 17

Describe autonomic dysfunction in acute hypoglycaemia

Answer 17

Patient gets warning before hypoglycaemic episode - sweating, tremors and confusion - giving time to take some sugar
Once patient has been diabetic for some time, the microvascular changes bunch closer together so the patient receives little warning

Question 18

What are large vessel complications of diabetes

Answer 18

Angina
MI
Claudication
Aneurysm

Question 19

What are small vessel disease complications of diabetes

Answer 19

Poor wound healing
Easy wound infections
Renal disease
Eye disease
Neuropathy

Question 20

What is neuropathy and how does it progress

Answer 20

Numbness of the feet - glove and stocking numbness
Long peripheral nerves lose function so patient doesn’t feel they have been wearing tight shoes, which rub, lead to blisters and become infected due to poor wound healing
Tissue requires to be amputated

Question 21

What changes are seen in diabetic eye disease

Answer 21

Cataracts
Maculopathy
Proliferative retinopathy

Question 22

What are cataracts and how are they fixed

Answer 22

White opacity within the iris suggests a cataract is present

Surgery is an easy fix

Question 23

What is diabetic retinopathy

Answer 23

Changes to the blood vessels growing out across the retina

They proliferate and produce thin poor walled vessels which will then haemorrhage onto the back of the eye

Question 24

How is diabetic retinopathy treated

Answer 24

Laser therapy where branches of the vessels are targeted and obliterated so that there is no longer any blood flowing through the weak walled areas to prevent damage in the long term

Question 25

Why is fasting a problem in type 1 diabetes

Answer 25

The patient needs insulin to prevent ketosis and carbohydrates to prevent hypoglycaemia

Question 26

What metabolic changes may diabetic patients experience in surgery

Answer 26

Hormone changes aggravate diabetes - adrenaline, cortisol, growth hormone
More glucose production and less muscle uptake
Metabolic acidosis more likely
Insulin requirements increased in type 1
Type 2 may require insulin cover perioperatively

Question 27

What should a dentist be aware of for patients with diabetes

Answer 27

Food intake may be disrupted in dental treatment
Be aware of acute emergencies and management of hypoglycaemia
Be aware of complications such as ischaemic heart disease, potential for dehydration
Be aware of infection risk and poor wound healing