Endocrine: Diabetes Flashcards
What are the two types of diabetes?
Mellitus and insipidus
What type of diabetes has 2 subdivisions? What are they?
Mellitus;
Type 1 - insulin dependant
Type 2 - non-insulin dependant
What is diabetes mellitus?
An abnormality in glucose regulation.
What is diabetes insipidus?
An abnormality in renal function
How do you test for diabetes mellitus?
GTT - Glucose tolerance test;
Patient fasts
Given fixed amount of sugar
Tested 2 hours later
RPG - Random plasma glucose
Tested randomly on 2 occasions.
In the Glucose tolerance test what levels indicate that the patient has diabetes?
If blood sugars are > 7 mol/l whilst fasting
If blood sugars are > 11.1 mol/l after the 2 hours.
In the Ransom plasma glucose test what levels indicate that the patient has diabetes?
If levels > 11.1 mol/l are recorded on the two occasions.
What is the cause of insulin dependant/type 1 diabetes mellitus?
Autoimmune disease that destroys pancreatic B cells.
What are the consequences of insulin dependant/type 1 diabetes mellitus?
Hyperglycaemia
Ketoacidosis
No B cells = no insulin = no movement of sugars into cells = cells = body metabolises ketones = produces acid = illness/death.
What is the onset of insulin dependant/type 1 diabetes mellitus?
Commonly occurs in young people.
However can occur as a child, adolescent or adult.
What are the symptoms of insulin dependant/type 1 diabetes mellitus?
Polyuria - frequent urination
Polydipsia - excessive thirst
Tiredness
When do those with insulin dependant/type 1 diabetes mellitus require insulin?
From diagnosis - rapid progression.
How do you diagnose Type 2/non-inulin dependant diabetes mellitus?
By excluding type 1
Carrying out RPG and Glucose tolerance testing. (more time to do so due to gradual onset)
What is the onset of Type 2/non-inulin dependant diabetes mellitus?
Commonly in those > 40
Onset is over many years
What rarely occurs in Type 2/non-inulin dependant diabetes mellitus?
Ketoacidosis (in contrast to type 1 )
What occurs in Type 2/non-inulin dependant diabetes mellitus?
Defective insulin secretion
Defective insulin resistance
Reduced glucose uptake in muscles
Increased hepatic glucose output.
What are the consequences of Type 2/non-inulin dependant diabetes mellitus?
High BP
Obesity
Early/accelerated atherosclerosis = CV disease, neuropathy.
Impaired glucose tolerance
What do those with Type 2/non-inulin dependant diabetes mellitus usually present with?
Complications of the disease
i.e. retinal damage and cardiovascular disease
Unusual infections
Sometimes they can present with symptoms.
List the differences between type 1 (ID) and type 2 (NID) diabetes.
Type 1: Ketacidosis occurs Common in the young Patients usually thin Present with symptoms (excessive urination and thirst) Genetic and Environmental triggers Possible family history of type 1 Possible family history of autoimmune diseases Irreversible
Type 2: Rarely ketoacidosis Common in those > 40 Patients usually overweight Usually present with complications rather than symptoms However symptoms are always present. Sometimes reversible with strict diet and exercise regimen. Strong family link Genetic trigger no environmental
How do you manage a Type 1 (ID) patient?
Subcutaneous insulin injections
must have insulin alongside sugars - insulin moves sugars into cells
How do you manage a Type 2 (NID) patient?
Weight loss via dietary restriction.
Preferred option: Insulin sensitisers: ensure cells respond more to insulin.
e.g. Biguuanines: metaformin.
Oral hypoglycaemia agents: Increase insulin secretion to move sugars out of the blood and into cells.
e.g. Sulphonylures
Surgery - gastric banding
What are the acute complications of diabetes mellitus?
Hypoglycaemia
Occurs in both type 1 and 2;
Insulin taken without food.
Those on oral hypoglycaemic agents (Type 2)
What are the chronic complications of diabetes mellitus?
Cardiovascular disease from restriction of large vessels (due to atherosclerosis)
e.g. angina, MI, claudication.
Small vessel disease:
e.g. poor wound healing, infection from poor wound healing, renal disease, eye disease and neuropathy.
Eye disease:
Cataract
Proliferative retinopathy - BV’s grow around the damaged retina.
Maculopathy - disease of the retina.
Neuropathy:
Numbness - prone to injury.
Motor neuropathy - weakening and wasting of muscle tissue = bowel and bladder dysfunction.
Autonomic regulation inability - lose awareness of a hypoglycaemic attack beginning.
What chronic CV complications arise from diabetes mellitus?
MI
angina
Claudication
From atherosclerosis and atheromas in larger vessels = reduced blood flow to cardiac muscle tissue.
What chronic neuropathic complications arise from diabetes mellitus?
Retinopathy
Autonomic regulation inability - lose awareness of hypoglycaemic attack.
Motor neuropathy - weakening and wasting of muscle tissue = Bladder and bowel dysfunction
Numbness - prone to injury.
From atherosclerosis = reduced blood flow to the nerves = reduced function and nerve tissue death.
What are the problems relating to surgical procedures (not healing) that are accompanied by diabetes mellitus?
Type 1 :
Cant fast before surgery.
Have to be taken into hospital before surgery and given IV sugar and insulin.
Type 2:
Have to be given insulin cover before/around surgical procedures.
What are the dental implications of diabetes?
Appointment times - important for type 1
Appointments after mealtimes.
Poor wound healing
Higher risk of infection
LA can induce hypoglycaemia = fainting (not the usual response but can happen)
Hypoglycaemia attack whilst sedated - can’t alert the dentist.
Symptoms of a hypo similar to the effects of sedation - hard to detect.
What causes type 2/non-insulin dependent diabetes?
bad dietary habits and low exercise
Practically; which diabetic individual is likely to undergo the diabetic testing?
Type 2 - gradual onset over many years.
Type 1 individuals go from health to severe illness very quickly.
What circulating antibodies are present in type 1 diabetes?
GAD
IAA
ICA
What influences type 1 diabetes?
Genetic and environmental factors.
What influences type 2 diabetes?
Genetic factors - no environmental factors
How do environmental factors trigger type 1 diabetes?
An individual can acquire an infection, if the antibodies produced against that infection also happen to attack the pancreatic B cells = type 1 diabetic.
If an individual has a active immune system as a child = more likely to have developed this as a child.
