Diabetes Mellitus Flashcards
What is Type 1 Diabetes?
An autoimune destruction of pancreatic beta cells resulting in a lack of insulin production
What is Type 2 Diabetes
Insulin resistance due to insulin signaling defect
What percent of women develop gestational diabetes?
4% or about 135,000 cases/yr
About how many americans have diabetes?
25.8 million (8.3%)
What percent of diabetics are Type 1?
5-10%
Define Polyuria and what causes it in diabetes.
Excess glucose, urea and ketone bodies are excreted and water goes with them
Define Polydypsia and what symptom of diabetes causes it.
Dehydration leads to excessive thirst
What dental issues come with polydypsia?
Xerostomia
Dental Caries
Define Polyphagia and what symptom of diabetes causes it?
Lack of insulin action on anorexigenic peptide synthesis leads to excessive hunger
What are the acute symptoms of uncontrolled diabetes?
Polyuria
Polydypsia
Polyphagia
What is Diabetic Ketoacidosis (DKA) caused by?
Insufficient insulin leading to persistent high blood glucose (>300mg%)
What is DKA often associated with?
Infection - 40%
Missed insulin - 25%
Untreated or undiagnosed - 15%
What are other stresses that may be associated with DKA?
Heart attack
Stroke
Trauma
Surgery
What are some symptoms of DKA?
Acetone Breath
Kussmaul breathing (short breath and increased respiration)
Excessively high blood glucose
What are the 4 main diagnostic tests for diabetes?
Fasting Plasma Glucose Test (FPG)
Oral Glucose Tolerance (OGTT)
Hemoglobin A1c
C-peptide
What is the pre-diabetic and diagnostic levels of FPG?
100-125 mg% in pre diabetics
>126 mg% is diagnostic
What is the pre-diabetic and diagnostic levels of OGTT?
140-199 mg% @ 2 hr is pre-diabetes
>200 mg% is diagnostic
What is the management goal of Hemoglobin A1c?
<7%
What does the C-peptide diagnostic test do?
Verifies Type 1
In the glucose tolerance test are [blood glucose] levels elevated or depressed?
Elevated when compared to normal
When HbA1c levels go up what happens to the blood glucose levels?
It increases at a proportional rate
What is a byproduct of converting proinsulin to mature insulin?
The C peptide
What is the treatment goal of diabetes?
Lower blood glucose level
What is the direct target of weight loss and what is its overall effect?
The direct target is adipose tissue with an overall effect of restoring insulin sensitivity
What is the direct target of exercise and what is its overall effect?
The direct target is Muscle and AMPK Activation with an overall effect of enhancing glucose uptake
What is the direct target of sulfonylureas and what is its overall effect?
The direct target is K+ channel blocker with an overall effect of enhancing insulin secretion
What is the direct target of Biguanides and what is its overall effect?
The direct target is AMPK activator with an overall effect of enhancing glucose uptake
What is the direct target of Thiazoladinediones and what is its overall effect?
The direct target is PPARgamma activator with an overall effect of potentiating insulin
What is the direct target of insulin and what is its overall effect?
The direct targets are muscle and adipose with an overall effect of enhancing glucose uptake
Long term sequelae of diabetes?
Diabetic Retinopathy Periodontal Disease CVD and Stroke End Stage Renal Disease Peripheral Neuropathy Prolonged wound healing Infection
What is glycation?
Stable, covalent ketoamine linkage of glucose to amino termini and lysine residues of proteins
What results in glycation?
Glucose spontaneously participating in a Schiff reaction
What are the end products of glycation called?
AGEs or Advanced Glycation End Products
What are receptors of AGEs called?
RAGEs
What do RAGEs trigger?
Increased oxidative stress
Mimics chronic inflammation via NFkB
What are some sequelae of Chronic Vascular Inflammation?
Increased risk for development of atherosclerotic plaques Impaired vasodilation Impaired flow-mediated dilation Impaired response to adenosine Increased stiffness of aorta Renal & Carotid artery stenosis
How does one diagnose Periodontitis?
Appearance of gingival Bleeding on probing Pocket probign depth Tooth Mobility Alveolar bone loss
What might perio disease contribute to?
Insulin resistance
At what percent is HbA1c considered to increased the risk of severe periodontal disease by 3?
9%
What does excess insulin lead to?
Hypoglycemia
What are the symptoms of hypoglycemia?
Confusion Irritability Sweating Shakiness Unconsciousness
What should you do if blood glucose is <70 mg%?
Use the rule of 15
What is the rule of 15?
15g carbs increases blood glucose by 15mg% in 15mins
