Endocrinology Flashcards
What cells does glucose bind to?
RBC and nerve cells
What are the hypoglycemic and hyperglycemic drugs we need to be aware of?
Hypoglycemic = insulin
Hyperglycemic = glucagon, growth hormone, catecholamines, cortisol
What cell is insulin made in?
Beta cells of islets of langerhan in the pancreas
Why do catecholamines raise blood sugar levels?
Released in response to stress to raise blood glucose for fight or flight response
What is the aetiology of type 1 diabetes?
Autoimmune condition causing destruction to pancreatic beta cells OR removal of pancreas
Are these conditions part of type 1 or type 2 diabetes?
1) Occurs in younger people
2) Weight loss is common
3) No links to HLA
4) Oral hypoglycemics is the treatment
1) 1
2) 1
3) 2
4) 2
What are the main symptoms of hyperglycemia?
Increasing frequency of passing urine Increases thirst Weight loss Fatigue Fat/protein breakdown
If a patient has a blood glucose of 7mmol/l after fasting, what does this suggest?
> 6.7mmol/l suggets diabetes
What are the 4 main oral hypoglycemics given?
- Sulphonylureas
- Glibenclamide
- Tolbutamide
- Biguanides
Why may we given a mixtard of insulin injections to a type 1 diabetic?
Mixture of short and long acting insulin yo try and smooth out peaks and troughs
What are the 4 main tests for blood glucose?
- Finger prick : do this in emergencies
- Urine tests : glucose appears in urine when levels are high
- Lab tests : accurate but takes hours for result
- HBA1C - measures glycosylated haemoglobin for long term monitoring
What oral hypoglycemic commonly causes a hypoglycemic emergency?
Sulphonylureas
What are some reasons why hypoglycemic attacks happen?
- Patient does not eat before appointment
- Liver and kidney failure stopping gluconeogenesis
- Excess alcohol inhibits gluconeogenesis
- Insuliomonas producing excess insulin
- Addison disease (low steroid level so less increase in blood glucose)
What signs and symptoms suggest a hypoglycemic attack?
- Hunger, sweating, increase in temperature
- Fear and aggression
- Altered peripheral sensation
If a patient having a hypo goes unconscious, what do we give them?
50% 50ml dextrose IV or glucagon 1mg intramuscular
Why does a ketoacidosis occur?
Occurs in someone who is an unknown diabetic or a diabetic missing medication.
What are the main ketones produced in ketoacidosis?
Acetate, acetoacetate and butyrate
What are the main complications to the blood vessels during diabetes?
Macrovascular : accelerates atheroma leading to MI and stroke risk
Microvascular:
Retinopathy - leading to blindness
Nephropathy - renal failure
Neuropathy - nerve damage causing tingling to peripheries
What is the dental relevance of diabetes?
- Infection : reduced polymorph function. May need antibiotic cover
- Oral candidiasis and dry mouth : poor infection control and reduction in saliva
- Periodontal disease and uncontrolled diabetes : reduction in defence mechanism, increase glucose in crevicular fluids
- Under GA: move to short acting insulin to gain stronger control, sliding scale needed
- Book early appointments and make sure patient eats before
What hormones are produced in the adrenal cortex?
STERIODS!
Fasciculata - mineralocorticoids (aldosterone)
Glomerulosa - glucocorticoids (coristol)
Reticularis - sex hormones
What are the main roles of glucocorticoids?
- Hyperglycemic molecule (increase blood sugar level)
- Increase protein breakdown
- Sensitise the arterioles to noradrenaline action
- Increase urine production (inhibits ACTH which works on kidney to allow water uptake)
What controls glucocorticoid release from the adrenal cortex?
- Hypothalamus releases corticotrophic release hormone to anterior pituitary
- Anterior pituitary releases ACTH which causes adrenal cortex to release cortisol
What controls glucocorticoid release from the adrenal cortex?
- Hypothalamus releases corticotrophic release hormone to anterior pituitary
- Anterior pituitary releases ACTH which causes adrenal cortex to release cortisol
What is caused by too many glucocorticoids?
What are the two reasons this may happen?
Cushings disease or syndrome
Disease = EXCESSIVE ACTH produced from pituitary adenoma, ACTH producing tumour
Syndrome = problem with adrenal cortex producing too many glucocorticoids