Endocrine Flashcards
why diabetes mellitus associated with loss of urine
Glucose in blood plasma exceeds the ability of the kidneys to resorb it back into the blood again so it goes into the urine. Osmotically draws liquid out so increased loss of urine, causing increased thirst
Difference between diabetes type 1 and 2
1=autoimmune destruction of Pancreatic Beta cells in islets of Langerhann so don’t produce enough insulin.
2= metabolic. combination of insulin resistance (increased glucose so have become de-sensitised) and relative lack of insulin to do its job properly
how is glucose stored
-glucose from diet is converted to glycogen (glycogenesis) by insulin and stored in muscles and liver
Which type of diabetes is insulin dependent. which is more common. what age is type 1 likely to manifest
type 1 insulin dependent - always needs insulin to treat
type 2 more common
10-14 years old
other than type 1 and type 2, what other causes of diabetes
gestational in pregnancy
secondary to other condition (Cushing’s syndrome or removing pancreatic cancer)
chronic kidney disease
symptoms of diabetes mellitus. Difference between type 1 and 2 manifestations
Both cause:
-polynuria - pass lots of urine
-polydipsia - drinks lots more to make up for urine loss
-weight loss - cells don’t take up glucose
-blurred vision - eye dehydration. (blood has higher osmotic pressure)
Type 2 - symptoms less rapid and dramatic. may be asymptomatic and find out during blood test. Can have increased infection such as candida or UTI.
how is type 2 diabetes diagnosed with the oral glucose tolerance test. what are the normal and abnormal values
-measure glucose level when fasted
-then give 75g of glucose
-measure glucose level after 2 hours
-in diabetes, glucose levels for both will be high
When fasted:
-normal <6.1 mmol/l
-diabetes >7.0
After 2 hours of glucose:
-normal <7.8
-diabetes >11.1
How glycated haemoglobin test is used to diagnose diabetes. Normal, pre-diabetic and diabetic levels
-Glycated hemoglobin [HbA1c] is a form of hemoglobin in RBCs that is chemically linked to a sugar
- RBCs last 120 days in the circulation so HbA1c level is a measure of the average blood glucose over several weeks
-Normal= <42 mmol/mol
-prediabetic = 42-47
-diabetic = ≥ 48
3 variations that type 2 diabetics can manage their diabetes
- Diet alone
- Diet plus drugs
- Diet plus insulin
Which hormones raise blood glucose, which lowers
-Raises= glucagon, cortisol, adrenaline, growth hormone
-lowers = insulin
does food, starvation, illness, stress, exercise, hypoglycaemic drugs cause increased or decreased blood glucose
-Increased= food, stress (increased cortisol), illness
-Decreased= hypoglycaemic drugs, insulin, exercise (uses up glucose for energy), starvation
Action of gliptens and glutides for type 2 diabetes. Name drugs
-increase insulin secretion [insulin secretagogues]
-sulphonylureas eg. gliclazide - oral
-DPP4 inhibitors eg. sitagliptin, vildaglipin - oral
-GLP-1 binders eg. exanetide, liraglutide - injected
Action of metformin (biguanides) for diabetes. side effects
-sensitises body to effects of insulin to improve its action (instead of getting body to produce more) -insulin sensitiser
-most common drug for type 2
-it can stimulate weight loss
-first choice for overweight patients
-can cause taste disorders
How alpha glucosidase inhibitors and guar gum work
-delay carbohydrate abdorption
-increase glucose loss in the urine
-associated with thrush
-rarely used
-can be used by cardiologists for patients with fluid overload
where to inject insulin. why it is not given orally.
Because insulin is broken down by digestive enzymes, it cannot be taken in pill form. Instead, it is delivered with a syringe into subcutaneous tissue where it can be absorbed into the blood
The layer of fat on the stomach, hips, thighs, buttocks and backs of the arms are common sites for injecting insulin.
-injected via needles or pens. Also can use pumps and inhalers
Explain short acting, long acting and biphasic insulin types. when they are taken.
- Short acting= injected right before meal. Peak insulin within an hour. [eg. soluble]
- Long/intermediate acting = taken a few hours before a meal. Insulin level long and slow, in blood for up to 12-24 hours. [eg. isophane]
- Biphasic = a mixture of a short-acting insulin with an intermediate-acting insulin. Can be used to cover mealtime and basal insulin requirements, and are often used twice a day
Name examples of insulin names and brands
-fast-acting= soluble [actrapid, humulin S], aspart [Novarapid], Lispro [Humalog], gluisine
-long-acting= isophane [insulatard, humulin l], glargine [Lantus], detemir [Levemir]
-biphasic= mixtard, humulin M3, Novomix 30, humalog Mix25
When is twice daily insulin injected. and the type of drug used
2x fast acting (soluble), 2x long acting (isophane insulin)
-injection initially before breakfast = 1 of each
-injection before dinner = 1 of each
Explain the basal-bolus insulin regime. what type of insulin used and when injected
-allows more flexibility for when you eat
-check insulin level before they eat and adjust the amount of insulin they need to inject in accordance with the amount of carbohydrate they are going to eat
-Long acting (eg. isoprene), given once a day.
-Then use short-acting (soluble) right before they eat
3 acute complications of diabetes (rapid onset)
- Hyperosmolar hyperglycaemic state
- Ketoacidosis
- Hypoglycaemia - complication of treatment
What is ketoacidosis. which diabetes it is likely to occur in. symptoms
-acute complication (12-24hrs) of type 1 diabetes, due to forgetting insulin or intercurrent illness
-hyperglycemia, osmotic diuresis
-low sugar stores to use as energy so the body starts breaking down fats at a high rate. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic
-Fast, deep breathing (trying to rid of acid)
-Dry skin and mouth. Thirst
-Flushed face.
-Fruity-smelling breath -like nail varnish remover
-Headache. Dehydration
-Muscle stiffness or aches.
-Being very tired. Confusion. Drowsiness
-Nausea and vomiting.
What is a Hyperosmolar hyperglycaemic state. which type of diabetes it occurs in. symptoms
-acute complication of type 2
-similar to ketoacidosis, but goes on for a few days rather than hours.
-happens when your blood glucose levels are too high for a long period, leading to urine loss, severe dehydration and confusion. HHS requires immediate medical treatment.
Name 2 chronic diabetic complications associated with eyes
- Diabetic retinopathy: damaged retinal blood vessels, causing micro aneurysms and sometimes microhaemorrhages. Usually asymptomatic if at periphery of eye, but if at centre of vision then noticeable
- Sub-hyaloid haemorrhage in eye: localized detachment of vitreous from the retina caused by accumulation of blood. Jagged lower border as blood moves down by gravity. Can lead to loss of vision when it takes place in the macular area.
Name 3 chronic diabetic complications associated with feet/ hands
1-Diabetic neuropathy: Numbness and tingling of hands and feet due to damaged nerves due to high glucose, or damaged vessels. Skin becomes thickned on feet and no good blood supply so becomes necrotic
2-Diabetic foot: damaged vessels can cause claudication of legs and feet (poor circulation and numbness)
3. Diabetic cheiroarthopathy: occurs in those with diabetic neuropathy. glucose binds to proteins and collagen. Loss of feeling in feet, fingers won’t fully straighten, damaged motor neves in hands
Name chronic diabetic complications associated with macrovasculature
-atherosclerosis, causing…
1. Peripheral - gangrene, claudication of hand and feet
2. Coronary - angina, MI
3. cerebral - strokes, TIA
How diabetes can affect the kidneys
-nephropathy: impaired kidney function. poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys that filter waste from your blood. This can lead to kidney damage and cause high blood pressure
How to treat retinopathy, nephropathy, neuropathy, peripheral vascular disease and foot ulcers associated with diabetes
- Retinopathy – laser photocoagulation (burns out bits of ischemic retina)
- Nephropathy – ACE inhibitors, dialysis & transplantation
- Neuropathy – advice about foot care. Amputation if necessary
- PVD – bypass surgery, angioplasty with stents or amputation
- Foot ulcers – chiropody, protection from pressure, good footwear & surgery
What blood glucose level is hypoglycaemia
<4 mmol/L
What are the warning and established symptoms of hypoglycaemia
1-Warning symptoms= adrenergic symptoms due to excess adrenaline to counteract.
-tremor, anxiety, palpitations, hunger, dry mouth
2-Established symptoms= neuroglycopenic symptoms due to brain not getting enough glucose/ energy.
-appear drunk
-confusion
-aggression
-slurred speach
-inco-coordination
-coma
-convulsions
-irreversible brain damage
-death
Treatment options for hypoglycaemia if conscious and unconscious
-establish diagnosis by checking blood glucose <4
-oral glucose tablets or drink (10-20g)
-buccal hypostop gel for uncooperative patient
If unconscious:
-subcutaneous glucagon 1mg
-IV glucose 20-30ml 50% (dextrose)
what type of patients will glucagon not work if they are hypoglycaemic
-doesn’t work for anorexic or severe starvation as no glucose stores
-liver disease - cirrhosis prevents glucagon from working
why important to inject glucose IV rather than subcutaneously
glucose is acidic so if went in subcutaneous tissues it may cause blackness of skin
how to inject glucagon (the form it is in and why. and where to inject) When is it used
Comes as dry powder to be drawn up with diluent – (as poor shelf life in solution)
Injected IM into outer thigh
-used for hypoglycaemic
Treatment of diabetic ketoacidosis and hypersomolar hyperglycaemic state
- Medical emergency
- IV insulin infusion
- IV rehydration and electrolyte replacement
- Treat underlying cause
- Secondary prevention – educating the patient about what to do next time
-hyperosmolar is same as DKA but slower correction and thromboprophylaxis (use heparin) to reduce risk of nephropathy, thrombosis
What a dentists should do with diabetic patients
- Ask about diabetes history
- Check control and usual treatment
- Check for relevant complications
- List first in morning – minimise disruption to routine. Advise them to eat as normal
- Check glucose before and after procedure, be prepared to treat hypoglycaemia
- Give a mid-morning snack before leaving surgery
- Remember increased infection risk with diabetic patients
inhaled insulin (rare) can cause dry mouth
soluble insulin may cause pain and swelling of salivary glands (although rare)
What sort of procedure require fasting. What should diabetic patients do
-endoscopy
-do procedure first on list, early in morning
-don’t take insulin or breakfast
-give breakfast and treatment immediately after
What is a GKI infusion and when it is used
-intravenous treatment for diabetic patients for major or longer procedure or under GA
-contains glucose, potassium and insulin
-Monitor glucose hourly – adjust insulin content of bag to keep between 6 and 12
Definition of gym steroids, steroid medication and biochemical steroids. what are the 5 steroid hormones
- Gym: synthetic analogues of testosterone to increase muscle
- Meds: hydrocortisone (eg. prednisolone) are synthetic analogues of cortisol for immunsupression
- Biochemical: steroids hormones derived from cholesterol and secreted in the blood (testeosterone, estrogen, preogesterone, cortisol, aldosterone)
Difference between the anterior and posterior pituitary (how it is connected to hypothalamus, what tissue it is composed of, what is does)
-Anterior pituitary= connected to hypothalamus by blood vessels. Composed of glandular tissues. Synthesises the hormones it secretes (FSH, LH, GH, TSH, ACTH, prostacyclin)
-Posterior pituitary =works via neuronal control (releases ADH and oxytocin) It stores hormones synthesised by the hypothalamus. Composed of neuronal tissue
Explain the hypothalamic pituitary axis
-The hypothalamus regulates the pituitary gland, involved in feedback cycles which determine what the other glands do
-Hypothalamus releases hormones which travel to the pituitary gland via pituitary stalk.
-Pituitary hormones are released into the general circulation.
-Hormones act on target organ (adrenal cortex, thyroid, liver, gonads, mammary gland,) and the glands produce hormones
-Once this hormone passes back to the hypothalamus, it downregulates it ensuring the appropriate amount is released (negative feedback)
