Endocrine Disorders 1 Flashcards
What does the endocrine system do
Coordinates the function of different organs through chemical messengers called hormones
What are the classifications of hormone
Classified as peptides, steroids or amino acids
What secretes hormones
Produced by endocrine glands and released in the bloodstream
What is the general function of hormones
- Influence the function of target tissues- other glands or organs
– Bind selectively to receptors located on the inside or on the surface of target cells
What mechanisms do endocrine disorders occur by
– Overproduction of hormones
– Underproduction of hormones
What are the causes (aetiology) of endocrine disorders
– Primary dysfunction of gland
– Secondary dysfunction of gland ( over or understimulation by other gland or exogeneous hormones)
– Receptor dysfunction
What diabetes is the most common and what is the difference between the 2 types
Type 2 = most common
Type 1 = lack of insulin
Type 2 = insulin resistance
What is the greatest risk factor for type 2 diabetes
Obesity
What are the osmotic symptoms of diabetes
- Polyuria
- Polydipsia
- Nocturia
- Weight loss
Besides osmotic tings what are the clinical presentations of diabetes
- Recurrent infections for e.g oral or genital candidiasis
- Lethargy
- Visual blurring
What is a diabetic emergency for type 1 DM and what are the symptoms
Diabetes Ketoacidosis -
- Osmotic symptoms
- Weight loss
- Abdominal pain
- Confusion
- Sweet smelling breath
What is a diabetic emergency for type 2 DM and what are the symptoms
Hyperosmolar hyperglycaemic syndrome (HHS) -
- Osmotic symptoms
- Dry mouth
- Confusion
- Hallucinations
- Reduced consciousness
- Coma
What microvascular complications can come from long term poorly controlled DM
– Retinopathy most common cause of adult blindness
– Nephropathy leading cause of chronic kidney disease
– Neuropathy
What complications can macrovascular atherosclerosis from long term poorly controlled DM cause
– Angina pectoris and myocardial infarction
– Transient ischaemic attacks and Cerebrovascular accidents
– Peripheral vascular disease leading to acute limb ischaemia, gangrene, amputation
What complications can symmetric polyneuropathy cause in diabetes
– Affects the distal feet and hands
– Causes paraesthesia, dysesthesias, or a painless loss of sense of touch, vibration, proprioception or temperature
– Lower extremities ~ blunted perception of foot trauma ~ foot ulceration and infection or to fractures, subluxation, and dislocation etc
What complications can autonomic neuropathy cause in diabetes
- Gastroparesis, erectile dysfunction, orthostatic hypotension, neuropathic bladder, impaired
What complications can mononeuropathy cause in diabetes
– Causes diplopia, ptosis when they affect the 3rd cranial nerve or motor palsies when they affect
the 4th or 6th cranial nerves
– Causes finger weakness and numbness (median nerve) or foot drop (peroneal nerve). Prone to nerve compression disorders, such as carpal tunnel syndrome
What complications can increased risk of infections and poor healing cause in diabetes
– Adverse effects of hyperglycaemia on granulocytes and T-cell function
– Prone to fungal and bacterial infection
– Examples include mucocutaneous candidiasis, bacterial foot infections
What symptoms are diagnostic for diabetes
- Random blood glucose ≥ 11.1 mmol/L
- Fasting blood glucose > 7.0 mmol/L
- Oral Glucose Tolerance Test (OGTT)
– 2 hour glucose ≥ 11.1 mmol/L after 75 g glucose load
What is HbA1c
- Glycated haemoglobin
- Average plasma glucose concentration over past 8-12 weeks
When can you not use Hb1Ac and what is used instead
- Cant use in presence of a haemoglobinopathy
- Fructosamine used instead
What treatment goals are there for diabetes
- Control hyperglycaemia to alleviate symptoms
- Prevention of complications
- Avoid hypoglycaemic episodes
- Goals for good glycaemic control - HbA1c levels < 48mmol/mol if on diet or metformin, 53 mmol/mol if no diet or metformin
- Address other cardiovascular risk factors
What are the management options for diabetes
- Patient education : Self monitoring/ target blood glucose
- Lifestyle measures: diet, exercise, weight
- Drugs: Oral medication +/- insulin
- Managing other risk factors : Lipid, BP, smoking, alcohol
- Assessment of complications
What are the aims for a good diabetic diet
– Low in saturated fat and cholesterol
– Contain reduced amounts of Carbohydrate, preferably from whole grain sources with higher fibre content
What is the treatment is there fore type 1 DM
Insulin
What treatment is there for type 2 DM
– If lifestyle changes are insufficient ~ single oral hypoglycaemic drug
– Combination therapy
– Addition of insulin if glycaemic control suboptimal with ≥ 3 agents
Name as many types of oral agent for diabetes treatment as you can
- Biguanides
- Sulphonylureas
- Thiozolinediones
- alpha-glucosidase inhibitors
- Meglitinides
- DDP-4 inhibitor
- SGLT-2 inhibitor
Name a type of biguanide and what its effect is
Metformin - reduces target tissue resistance
name a type of sulphonylurea and what its effect is
Gliclazide - stimulates insulin release
name a type of thiozolinedione and what its effect is
Pioglitazone - alleviates insulin resistance
name a type of alpha-glucosidase inhibitors and what its effect is
Acarbose - delays intestinal breakdown of oligosaccharides to glucose
name a type of meglitinides and what its effect is
Repaglinide - stimulates insulin release
name a type of DDP-4 inhibitor and what its effect is
Sitagliptin - stimulates insulin production through the GLP-1 pathway
name a type of SGLT-2 inhibitor and what its effect is
Dapagliflozin - excrete glucose through urine
Name the options for non-insulin injectables and how frequently each should be taken
– Liraglutide ( daily)
– Dulaglutide ( weekly)
– Exenatide ( twice daily)
– Exenatide ( weekly)
Name some short acting insulin drugs and when they should be taken
Novorapid, Humalo, Humulin S
- used at mealtime to control postprandial spikes in glucose
Name some long acting insulin drugs and when they should be taken
Detemir, Glargine, Degludec
- Provides a steady basal effect over 24h
What are the insulin injection sites
- Abdomen
- Buttocks
- Upper outer arms
- Upper outer thighs
Name some oral manifestations that can arise from diabetes
- Chronic/aggressive periodontitis
- Severe dentoalveolar abscesses with facial space involvement
- Dry mouth~ secondary to dehydration and decreased salivary flow
- Oral lichenoid reaction ~ side effects of oral hypoglycaemic such as Metformin
- Oral candidiasis, angular chelitis
Why should diabetic patients be raised slowly upright in a dental chair
Risk of orthostatic hypotension as a result of autonomic neuropathy
When should diabetics start eating again after dental treatment and what should they do if they have a limited ability to chew
- Patients should resume normal diet following procedure as soon as possible
- Patients with limited ability to chew after dental procedure should be instructed to have soft food or liquid to maintain glucose levels
What affect do steroids have on diabetic patients
Worsens glycemic control
What affect do steroids have on diabetic patients
Worsens glycemic control
