Endocrine- diabetes Flashcards
How can you test a patient for diabetes?
- Glucose tolerance test (75g of glucose after fasting- >7 =diabetic)
- Random glucose test (need a score of 11.1 mmol/l twice to be diabetic )
- 2 hour glucose test >7.8= impaired glucose tolerance >11.1 = diabetic
What is impaired glucose tolerance?
When the patient produces less insulin so the body blood sugar takes longer to return to normal.
What is hyperglycaemia?
High blood sugar
How does ketoacidosis happen?
Low insulin causes low sugar level in the cell.
This causes ketones to be metabolised.
Increased acidity of blood.
Causing ketoacidosis.
What antibodies present in the blood tell you about the disease process?
GAD
ICA
IAA
What happens in adult onset diabetes?
There is a slower rate of losing pancreatic islet cells. It therefore takes longer to lose the insulin supply.
What are the symptoms of diabetes?
Polyuria
Polydipsia
Tiredness
What is the glycaemic status?
Ability to make insulin.
Why does type 2 rarely cause ketoacidosis?
The glycaemic status takes so long to diminish.
Discuss the insulin level in a type 2 diabetic
Higher normal insulin level (basal)
Type 2 diabetes causes a defect in insulin secretion. What is the result?
Inadequate response of B cells to hyperglycaemia.
Type 2 diabetes causes a failure in insulin suppression. What is the result?
Increase in the normal hepatic Glucose output.
Type 2 diabetes causes a failure of insulin promoting glucose conversion. What is the result?
Reduced muscle glucose update (normally stimulated by insulin)
What is hyperinsulinaemia?
High blood insulin level.
What is Dyslipidaemia?
High levels of LDL- bad cholesterol.
Low levels of HDL good cholesterol
Discuss the Treatment for type 1 diabetes:
Insulin subcutaneously:
Depdenent on number of injections:
-Basal bolus= more injections (can do yourself)
Split mixed= less injections but have to fit yourself around NHS.
What happens if a patient has too much insulin?
Hypoglycaemia.
What is the treatment for type 2 diabetes.
- Weight loss
Change of diet- avoiding refined carbs/ saturated fats. Eat more fibre
Surgery- gastric band
Pills
- Oral hypoglycaemic agents. (to reduce blood sugar)
What are insulin secretagogues?
Hypoglycaemic agents that increase pancreatic insulin secretion to cause hypoglycaemia.
e.g. sulphonylureas such as Glicazides.
What are insulin sensitizers?
Hypoglycaemic agents that increase sensitivity to insulin and reduce hepatic glucose production.
In order to cause hypoglycaemia.
e.g. biguanides such as metaformin.
When would you use insulin in type 2 diabetics?
If the patient is unable to achieve glycaemic control using weight loss or oral hypoglycaemic agents.
You would use insulin with an insulin sensitiser such as metaformin
- What is neuropathy?
When the nerve supplying your body die off.
This causes the weakness and wasting of muscles & affects autonomic regulation:
- lose awareness of hypoglycaemia .
- Bladder and bowel dysfunction
- Loss of reflexes that maintain posture.
What do you need to be aware of when treating patients with diabetes?
- Fasting for operations- they could have a hypo
- Organise appointments after mealtimes- so appointment does not affect their eating habits.
- More prone to infection.
- Poor wound healing
- May have to give them an increased insulin dose before (type 1) or dosage during (type 2)
- Metabolic changes aggrevate diabetes (Adrenaline). Causing more glucose production and less muscle uptake. Making metabolic acidosis more likely.
A patient has a HYPO in your clinic?
What do you do?
Patient concious- give them oral sugar tablet
Patient unconcious- glucagon IM & high sugar gel squeezed under the tongue (subcutaneous)
How does Diabetes affect a patient’s oral health?
• Reduced salivary flow
• Xerostomia
• Burning mouth/tongue
• Are more prone to periodontitis and gingivitis
• Greater risk of candida infections.
• Poor wound healing
• Greater risk of infection
• Parotid gland swelling
• Sialosis (salivary gland swelling)
