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BDS2 BAMS > Diabetes melitus > Flashcards

Diabetes melitus Flashcards

1
Q

When we talk about diabetes. Which type are we usually talking about?

A

Diabetes mellitus

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2
Q

What is diabetes mellitus?

A
  • Abnormality of GLUCOSE regulation

- Metabolic disease

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3
Q

When testing for diabetes mellitus what should you test? (3 points)

A
  • Random test
  • Fasting test
  • Glucose tolerance test
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4
Q

How do you do a random test for diabetes mellitus?

A
  • 2 random glucose tests above 11 suggest you have diabetes
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5
Q

How do you do a fasting test to test for diabetes mellitus?

A
  • Have nothing for 8 hours then take a sample
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6
Q

What is a glucose tolerance test?

A

Standardised test - test blood sugar having patient fasted then give a fixed dose of sugar and test after 2 hours (levels should be in a specific range)

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7
Q

What is diabetes insipidus?

A
  • Abnormality of RENAL FUNCTION (water)
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8
Q

What is meant by the ‘impaired’ group when testing for diabetes?

A
  • They are pre-diabetic/ have impaired glucose tolerance
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9
Q

When taking a glucose tolerance test, what should the fasting plasma glucose be for a normal person before the test?

A

<6.1

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10
Q

When taking a glucose tolerance test, what should the fasting plasma glucose be for an impaired fasting glucose person before the test?

A

6.1-7.0

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11
Q

When taking a glucose tolerance test, what should the fasting plasma glucose be for a diabetic person before the test?

A

> 7.0

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12
Q

When taking a glucose tolerance test, what should the fasting plasma glucose be for a normal person 2 hours after the test?

A

<7.8

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13
Q

When taking a glucose tolerance test, what should the fasting plasma glucose be for an impaired glucose tolerance person 2 hours after the test?

A

7.8-11.1

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14
Q

When taking a glucose tolerance test, what should the fasting plasma glucose be for a diabetic person 2 hours after the test?

A

> 11.1

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15
Q

What is the definition for type 1 diabetes?

A

Insulin deficiency

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16
Q

What is the definition for type 2 diabetes?

A

Insulin resistant

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17
Q

Both type 1 and type 2 diabetes are related to blood sugar levels but that is different?

A
  • The processes are completely different
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18
Q

What happens in type 1 diabetes?

A

Immune mediated pancreatic B cell destruction

  • hyperglycaemia
  • Ketoacidosis
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19
Q

What is hyperglycaemia?

A

An excess of glucose in the blood

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20
Q

What is ketoacidosis?

A

Complication of type 1 diabetes. It is a life-threatening condition resulting from dangerously high levels of ketones and blood sugar

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21
Q

Which antibodies are circulating in the blood in type 1 diabetes? (3 points)

A
  • GAD (glutamic acid decarboxylase)
  • ICA (Islet cell antibodies)
  • IAA (insulin autoantibodies)
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22
Q

Is type 1 diabetes influenced by genetic or environmental factors?

A
  • Both involved
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23
Q

If a monozygotic twin has type 1 diabetes, what is the likelihood of the other twin having it?

A

40% chance

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24
Q

When does onset of type 1 diabetes usually occur?

A
  • Usually childhood/adolescence but can be adult onset
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25
Q

When does peak incidence of type 1 diabetes occur?

A

10-14 years

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26
Q

When does up to 60% of cases of type 1 diabetes occur?

A

AFTER the age of 16

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27
Q

Classically in children with type 1 diabetes, which antibodies tend to be in a higher concentration?

A
  • ICA, IAA
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28
Q

What does LADA stand for?

A

Latent autoimmune diabetes in adults (type 1 diabetes for adults)

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29
Q

Is type 1 diabetes in adults GAD associated?

A
  • Yes, there is generally lower AB levels
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30
Q

Is there more or less weight loss and ketoacidosis in adult onset type 1 diabetes?

A

less

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31
Q

What may type 1 diabetes in adults be thought of as?

A

‘non-obese’ type 2

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32
Q

Is insulin required immediately for adults with type 1 diabetes?

A
  • There is a variable period until insulin is required
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33
Q

What are common symptoms of type 1 diabetes? (3 points)

A
  • Polyuria
  • Polydipsia
  • Tiredness
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34
Q

What is polyuria?

A

Production of abnormally large volumes or dilute urine

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35
Q

What is polydipsia?

A

Abnormally great thirst

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36
Q

What are symptoms of acute presentation type 1 diabetes? (2 points)

A
  • Hyperglycaemia with diabetic symptoms

- Ketoacidosis

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37
Q

Does type 1 diabetes usually require insulin from diagnosis?

38
Q

Hoe do you diagnose type 2 diabetes?

A
  • By excluding type 1 diabetes
39
Q

What is type 2 diabetes strongly associated with? (2 points)

A
  • obesity & inactivity
40
Q

Typ1 2 diabetes is usually occurs in patients over 40 yrs of age. What is the name for typ1 2 diabetes that occurs in people younger than this?

A

Maturity Onset Diabetes in the Young (MODY)

41
Q

Do people with type 2 diabetes become ketoacidotic?

42
Q

If an identical twin has type 2 diabetes, will the other twin also get it?

A
  • Yes, strong family history - 100% concordance in identical twins
43
Q

Type 2 diabetes is a metabolic disorder. What does this cause? (4 points)

A
  • Defect in insulin resistance (elevated basal insulin levels)
  • Defect in insulin secretion (B cell response to hyperglycaemia is inadequate)
  • Basal hepatic glucose output increased (failure of insulin suppression)
  • Insulin stimulated muscle glucose uptake is reduced (failure of insulin promotion)
44
Q

What can type 2 diabetes cause? (7 points)

A
  • Impaired glucose tolerance
  • Hyperinsulinemia
  • Hypertension
  • Obesity with abnormal distribution
  • Dislipidaemia
  • Procoagulant epithelial markers
  • Early and accelerated atherosclerosis
45
Q

What is hyperinsulinemia?

A

Increased level of insulin in the blood

46
Q

What is dyslipidaemia?

A
  • Abnormally high levels of lipids in the blood
47
Q

Is type 2 diabetes gradual onset?

48
Q

Is there often retinal damage at diagnosis of type 2 diabetes?

49
Q

Does the ability to secrete insulin fall with time with someone with type 2 diabetes?

50
Q

Type 2 diabetes is rarely an acute presentation. Are the common signs of polyuria, polydipsia and tiredness present?

51
Q

Do people with type 2 diabetes usually get unusual infections?

52
Q

What is a good preventative measure (management) for someone with type 2 diabetes?

A
  • Strict diet and exercise
53
Q

Education is a way of managing diabetes. What would you educate people about? (4 points)

A
  • About diabetes
  • Managing diabetes
  • Health care issues
  • Compliance avoidance
54
Q

What is the target glucose concentration to manage diabetes pre-prandial and at bedtime.

A

Preprandial = 4-6mmol/L

Bedtime = 6-8mmol/L

55
Q

What can be used to manage diabetes? (2 points)

A
  • Drugs

- Insulin

56
Q

When using basal-bolus control insulin. how many injection should be given?

A
  • More injections = better
57
Q

when using split-mixed control insulin. How many injections should be given?

A

Fewer injections - poorer

58
Q

Can insulin be inhaled?

59
Q

In relation do nutrition, how would you manage diabetes? (3 points)

A
  • Less thsn 10% calories from saturated fat
  • Glycaemic index of foods compared with standard food
  • Carbohydrate counting
60
Q

What route of administration is insulin administered for type 1 diabetes?

A

Subcutaneously

  • Different preparations available (time to act from injection varies)
61
Q

What is the aim for ideal blood sugar levels for a type 1 diabetic?

A
  • Ideal sugar 4<7 (often may accept slightly higher)
62
Q

What can be done as management for type 2 diabetes? (4 points)

A
  • Weight loss
  • Diet restriction
  • ‘Diet pills’
  • Surgery
63
Q

Diet restriction is one way of managing type 2 diabetes. How can this be done? (3 points)

A
  • Avoid refined CHO
  • Encourage high fibre food
  • Reduce fat, esp. saturated
64
Q

‘Diet pills’ can be used as management of type 2 diabetes. Give 2 examples of these?

A
  • Orlistat

- Sibutramine

65
Q

Surgery can be used as a way to manage type 2 diabetes. Give 2 examples of surgery’s to help with this?

A
  • ‘Gastric bypass’

- Gastric vertical banding

66
Q

Oral Hypoglycaemic agents can be used to manage type 2 diabetes. One example of these are insulin secretagogues. Give 4 examples of these?

A

Sulphonylureas

  • Gliclazide
  • Glibenclamide
  • Tolbitamide
  • Chlorpropamide
67
Q

Oral Hypoglycaemic agents can be used to manage type 2 diabetes. One example of these are insulin sensitizers. Give 2 examples of these?

A

Biguanides

  • Metformin

Thiazolidinediones

  • Rosiglitazone
68
Q

Sulphonylureas are examples of common oral hypoglycaemic’s. How do they work?

A

INCREASE pancreatic insulin secretion

69
Q

Biguanides are examples of common oral hypoglycaemic’s. How do they work? (3 points)

A
  • Enhanced cell insulin sensitivity
  • Reduce hepatic gluconeogenesis
  • (preferred in the obese)
70
Q

How are people with type 2 diabetes able to maintain glycaemic control? (3 points)

A
  • Behavioural changes
  • Body weight reduction
  • Oral hypoglycaemic agents
71
Q

Are there benefits of taking insulin treatment after MI in type 2 diabetics?

72
Q

What are acute complications of diabetes? (3 points)

A

Hypoglycaemia

  • Type 1
  • Type 2 on sulphonylurea or insulin
  • Insulin/drug without food
73
Q

What are chronic complications of diabetes? (3 points)

A
  • Cardiovascular risk
  • Infection risk
  • Neuropathy
74
Q

What is neuropathy?

A

When the nerves supplying your body die off - because nerves have a blood supply to keep them alive - the CVD affecting the blood vessels can cause the nerves to die off

75
Q

What is a diabetic complication of large blood vessels?

A
  • Risk of atheroma:

- Angina, MI, Claudication, Aneurysm

76
Q

What are diabetic complications of small blood vessels? (5 points)

A
  • Poor wound healing
  • Easy wound infections
  • RENAL disease
  • EYE disease
  • Neuropathy
77
Q

What are examples of eye diseases that can be caused by diabetes? (3 points)

A
  • Cateracts
  • Maculopathy
  • Proliferative retinopathy
78
Q

What is a possible treatment for eye diseases that can be caused by diabetes?

A

LASER treatment

79
Q

What are Cataracts?

A
  • Opacities in the lens

- Lens in the eye has coagulated and you can’t see properly

80
Q

What is retinopathy?

A

Disease of the retina which results in impairment or loss of vision

81
Q

What is proliferative retinopathy?

A
  • The retina is the film at the back of your eye, and the tiny blood vessels are capillaries. These growing blood vessels are very delicate and bleed easily. Without laser treatment, the bleeding causes scar tissue that starts to shrink and pull the retina off, and the eye becomes blind
82
Q

What is laser ablation?

A

A process in which a laser beam is focused on a sample surface to remove material from the irradiated zone

83
Q

What is the general sensation of diabetic neuropathy?

A

‘Glove & stocking’

84
Q

What is the ‘motor neuropathy’ in diabetic neuropathy?

A

Weakness and wasting of muscles

85
Q

What are the ‘autonomic regulation’ elements of diabetic neuropathy? (3 points)

A
  • Awareness of hypoglycaemia lost
  • Postural reflexes
  • Bladder & bowel dysfunction
86
Q

When getting surgery, why can fasting be a problem in type 1 diabetes? (2 points)

A
  • Need insulin to prevent ketosis

- Need carbohydrate to prevent hypoglycaemia

87
Q

What are examples of metabolic changes that are associated with surgery that can affect type 1 + type 2 diabetics? (3 points)

A
  • Hormone changes aggravate diabetes (epinephrine, cortisol, growth hormone)
  • More glucose production and less muscle uptake
  • Metabolic acidosis more likely
88
Q

What is metabolic acidosis?

A

A condition in which there is excess acid in the bodily fluids

89
Q

What is the treatment for type 1 and type 2 diabetics if they have metabolic changes after surgery? (2 points)

A
  • Type 1 = increased insulin requirements

- Type 2 = May require insulin cover perioperatively

90
Q

What should a dentist be aware of when treating a diabetic? (5 points)

A
  • Be aware of the effect of dental treatment (food intake may be disturbed)
  • Be aware of acute emergencies
  • Be aware of diabetic complications (IHD, dehydration, neuropathy, eyes)
  • Be aware of INFECTION RISK
  • Be aware of POOR WOUND HEALING

BDS2 BAMS (57 decks)

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