Diabetes summary Flashcards
Which age group is mostly affected by diabetes?
Over 65
Which type of diabetes is most common (90%)?
Type 2
Give 4 types of diabetes.
Type 1
Type 2
Secondary
Mono genetic
What is type 1 diabetes?
Autoimmune destruction of beta cells in pancreas leading to reduced insulin production.
Gradual onset.
What is type 2 diabetes?
Body becomes increasingly resistant to the effects of insulin.
pancreas works harder to control plasma glucose levels
eventually pancreas becomes tired with consequent Fall in insulin production.
What is secondary diabetes?
1) Resulting from another condition causing some kind of insult to the pancreas
- e.g. pancreatitis,
2) Endocrinopathies e.g. (acromegaly, Cushing’s)
3) drug or chemicals e.g. steroids.
What effect can steroids have on diabetes?
Can induce secondary diabetes due to increasing blood glucose levels.
What is mono genetic diabetes?
Diabetes due to a specific genetic defect.
don’t fit criteria for T1D or T2D
Signs and symptoms of undiagnosed diabetes.
- Thirst
- Polydipsia (excreting glucose in urine to remove from blood)
- Polyuria
- Weight change (sugar not converted to fat stores but removed in the urine)
- Lethargy
- Skin changes
- Blurred vision
- Recurrent infections e.g. Candida
What is an oral sign of undiagnosed diabetes?
Candida
recurrent oral thrush
Why do patients get polydipsia and polyuria?
Body is trying to remove excess glucose.
This glucose then can’t be stored in fat stores and so there is weight loss.
What is normal blood glucose levels?
4-7 mmol/L
What is required to diagnose diabetes?
Asymptomatic patient - 2 diagnostic blood tests.
Symptomatic patient - 1 diagnostic blood test.
What does HbA1c reflect?
monitoring pts glycaemic control
Blood glucose levels over the preceding 2-3 months (RBCs lifespan in 2-3 months)
The higher the glucose, the more glucose is stuck to the RBCs, the higher the HbA1c.
What are the two main groups of diabetes complications?
Macro vascular and micro vascular.
What are the macro vascular complications of diabetes?
Coronary artery disease
- leading to angina or myocardial infarctions
cerebrovascular disease
- leading to stroke
peripheral vascular disease
- foot ulcers or an acutely ischaemic limb
What are the micro vascular complications of diabetes?
Peripheral neuropathy
- lead to reduced sensation
retinopathy
- problems with pt eye sight
nephropathy
- kidneys to lead protein and impair kidney function
autonomic neuropathy
- cause issues with stomach and bowl mobility, cause nausea and faecal incontinence
What is a normal ketone level in the blood?
<0.6
A ketone level of what indicates DKA and requires immediate action?
> 1.5
Treatment for type 1 diabetes?
Insulin
Treatment for type 2 diabetes?
Diet, exercise, drugs, insulin, combination of these.
Which drug is first line for treating type 2 diabetes?
Metformin
What type of drug is glicazide?
Oral sulfonylurea (used for T2 diabetes).
What did the DiRECT study show?
Weight loss can put diabetes into remission for 5 years.
What effect does diabetes have on periodontal disease?
Increased extent and severity.
Diabetes and perio have a bi-directional relationship.
How can diabetes affect oral health?
Increased extent and severity of perio
Prevalence of caries
Burning mouth syndrome
Candida infection
Xerostomia
Altered taste sensation
Altered tooth eruption
Hypertrophy of parotid glands
What effects does chronic hyperglycaemia have on oral health?
Infection and delayed wound healing
Fungal infection
Lichen planus / lichenoid reactions
Perio
Salivary gland dysfunction
Taste impairment
Caries
How should you treat someone having a hypoglycaemic attack?
Give them sugar - 15-20g fast acting carbohydrate e.g. glucotabs, glucogel, sweets, 150-200ml orange juice (other sugary drinks not recommended).
Check blood glucose levels in 10-15 mins.
If blood glucose levels are still low, repeat the sugar (do this up to 3 times).
If still low, call a doctor.
Consider IM glucagon.
After, give a carbohydrate snack e.g. toast, biscuits.
What is relative hypoglycaemia?
Patient feels low but their blood glucose level is above 4.
Causes of hypoglycaemia?
Insulin therapy, sulfonylurea therapy.
Patients with which type of diabetes experience more hypos?
Type 1
What are some symptoms of hypoglycaemia?
Sweating, confusion, drowsiness, speech difficulty, in coordination, malaise, headache, palpitations, hunger, trembling.
What are the different ways in which glucose is made?
Oral intake - absorbed from gut.
Hepatic - gluconeogenesis, glycogen breakdown.
What are some possible adverse effects of hypoglycaemia?
Coma, seizure, hemiplegia (stroke mimic), fractures due to seizure triggered by hypo, cardiac problems (MI, angina).
What is impaired awareness of hypoglycaemia?
Occurs in patients with repeated hypos.
Warning symptoms of a hypo are reduced in intensity or disappear completely.
How to manage a patient having a hypo who is confused and disoriented but able to swallow?
Glucogel or IM glucagon.
How does glucagon work?
Mobilises glycogen from the liver.
What happens to blood glucose levels when patients are unwell?
Higher due to release of stress hormones.
Therefore T1 diabetics should not stop insulin.
Signs of DKA?
Increased respiratory rate
Ketones on breath (pear drops)
Nausea
Vomiting
Sick day rules for T1 diabetes?
Don’t stop insulin.
If blood glucose levels high, check ketones.
Drink plenty.
Check blood glucose levels regularly.
Sick day rules for T2 diabetics?
Rest, fluids, treat associated symptoms, consider abx, monitor blood glucose, adjust diabetes meds (stop metformin if dehydrated).
What is DKA and what characterises it?
Complex metabolic state characterised by hyperglycaemia, acidosis and ketoaemia.
What blood glucose level indicates a patient is at risk of DKA?
11
How to treat DKA?
Insulin
What type of foods to avoid when treating a hypo?
Things containing fat e.g. chocolate because this will act too slow.
What therapy is needed in type 1 diabetes?
insulin replacement is essential
Is the onset of T1D gradual or rapid?
gradual, especially in older pts
MODY?
maturity onset diabetes of the young, previous name for monogentic diabetes
mode of inheritance of monogenetic diabetes?
autosomal dominant inheritance
genetic mutations associated with monogentic diabetes?
glucokinase
HNF1A
HNF4A
What is used to monitor glucose levels?
capillary blood glucose monitoring
why are ketone levels important?
indicate absolute lack of insulin
normal is under 0.6
what is a flash CGM?
measures glucose level of the interstitial tissue under the skin (0.5cm)
lasts 14 days and scans every at least every 8 hours
who wears a flash CGM?
T1D
what are 2 ways to monitor glucose levels?
flash CGM and continuous glucose monitoring
link between gingivitis and diabetes?
pt with gum disease is more likely to get diabetes and visa versa
BI-DIRECTIONAL
if you improve perio you can help diabetes
stress hyperglycaemia?
chronic inflammation/perio can lead to stress hyperglycaemia and poor glucose control
when would you be inclined to screen a pt for diabetes?
recurrent fungal infection
what is shown?
lichen planus with T2DM
lacey white patches on buccal mucosa
painful and or itchy
What can trigger lichen planus?
viral infection
T2DM
stress
what is shown?
oral candidiasis
can be caused by poorly controlled T2DM
Risk factors for oral candidiasis?
T2DM
fungal infections elsewhere
smoking
ab therapy
inhaled steroids
when may hyperglycaemia occur?
stress- adrenaline and cortisol increase blood glucose levels
What level is blood glucose to be classed as hypoglycaemia?
below 4
What level is severe DKA?
7.1
tx for DKA?
Insulin
IV fluids
K replacement
