Endocrine- diabetes

Question 1

How can you test a patient for diabetes?

Answer 1

• 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

Question 2

What is impaired glucose tolerance?

Answer 2

When the patient produces less insulin so the body blood sugar takes longer to return to normal.

Question 3

What is hyperglycaemia?

Answer 3

High blood sugar

Question 4

How does ketoacidosis happen?

Answer 4

Low insulin causes low sugar level in the cell.

This causes ketones to be metabolised.

Increased acidity of blood.

Causing ketoacidosis.

Question 5

What antibodies present in the blood tell you about the disease process?

Answer 5

GAD

ICA

IAA

Question 6

What happens in adult onset diabetes?

Answer 6

There is a slower rate of losing pancreatic islet cells. It therefore takes longer to lose the insulin supply.

Question 7

What are the symptoms of diabetes?

Answer 7

Polyuria

Polydipsia

Tiredness

Question 8

What is the glycaemic status?

Answer 8

Ability to make insulin.

Question 9

Why does type 2 rarely cause ketoacidosis?

Answer 9

The glycaemic status takes so long to diminish.

Question 10

Discuss the insulin level in a type 2 diabetic

Answer 10

Higher normal insulin level (basal)

Question 11

Type 2 diabetes causes a defect in insulin secretion. What is the result?

Answer 11

Inadequate response of B cells to hyperglycaemia.

Question 12

Type 2 diabetes causes a failure in insulin suppression. What is the result?

Answer 12

Increase in the normal hepatic Glucose output.

Question 13

Type 2 diabetes causes a failure of insulin promoting glucose conversion. What is the result?

Answer 13

Reduced muscle glucose update (normally stimulated by insulin)

Question 14

What is hyperinsulinaemia?

Answer 14

High blood insulin level.

Question 15

What is Dyslipidaemia?

Answer 15

High levels of LDL- bad cholesterol.

Low levels of HDL good cholesterol

Question 16

Discuss the Treatment for type 1 diabetes:

Answer 16

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.

Question 17

What happens if a patient has too much insulin?

Answer 17

Hypoglycaemia.

Question 18

What is the treatment for type 2 diabetes.

Answer 18

• Weight loss

Change of diet- avoiding refined carbs/ saturated fats. Eat more fibre

Surgery- gastric band

Pills

• Oral hypoglycaemic agents. (to reduce blood sugar)

Question 19

What are insulin secretagogues?

Answer 19

Hypoglycaemic agents that increase pancreatic insulin secretion to cause hypoglycaemia.

e.g. sulphonylureas such as Glicazides.

Question 20

What are insulin sensitizers?

Answer 20

Hypoglycaemic agents that increase sensitivity to insulin and reduce hepatic glucose production.

In order to cause hypoglycaemia.

e.g. biguanides such as metaformin.

Question 21

When would you use insulin in type 2 diabetics?

Answer 21

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

Question 22

• What is neuropathy?

Answer 22

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.

Question 23

What do you need to be aware of when treating patients with diabetes?

Answer 23

• 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.

Question 24

A patient has a HYPO in your clinic?

What do you do?

Answer 24

Patient concious- give them oral sugar tablet

Patient unconcious- glucagon IM & high sugar gel squeezed under the tongue (subcutaneous)

Question 25

How does Diabetes affect a patient’s oral health?

Answer 25

• 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)