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Dentistry Human Disease > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What group of diseases are characterised by dysfunction of hormone secreting glands?

A

Endocrine disease

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2
Q

What is meant by negative feedback regulation?

A

Where the increasing level of the control hormone causes a reduction in secretion of the active hormone

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3
Q

What is secondary failure of the endocrine system?

A

Control failure (e.g. where a master gland, such as the pituitary gland, stops working and cant regulate other glands)

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4
Q

What is primary failure in the endocrine system?

A

Dysfunction/failure originating in the peripheral endocrine gland itself

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5
Q

What is multiple endocrine neoplasia (MEN)?

A

Condition causing overgrowth or tumours on one or more endocrine glands

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6
Q

What is MEN 1?

A

A hereditary condition associated with tumours of the hormone producing endocrine glands (e.g. parathyroid, anterior pituitary, pancreatic islets)

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7
Q

Where are the most common associated tumours of MEN 1 found?

A

Adrenal cortex

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8
Q

What are commonly associated tumours of MEN 1?

A

Adrenal cortex, Carcinoid and lipoma

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9
Q

What is MEN 2a?

A

Condition characterised by medullary carcinoma of the thyroid, Phaeochromocytoma, parathyroid hyperplasia etc.

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10
Q

What is MEN 2b?

A

Rare inherited disorder characterised by medullary thyroid cancer, mucosal neuromas, Marfanoid appearance etc.

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11
Q

Where is the pituitary gland located?

A

In a small depression in the middle of the skull base, the sella turcica.

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12
Q

What are the two components of the pituitary gland?

A

Anterior and posterior

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13
Q

What controls the pituitary gland?

A

The hypothalamus

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14
Q

Which component of the pituitary gland only releasing hormones upon vascular control?

A

Anterior pituitary

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15
Q

Which component of the pituitary gland releases hormones upon vascular and neural control?

A

Posterior pituitary

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16
Q

How can growth of the pituitary gland affect vision?

A

Any growth of the pituitary gland will head upwards due to pressure of surrounding bone and cause trauma/ put pressure on the optic chiasma which will effect vision

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17
Q

Which two hormones is the posterior pituitary gland mostly concerned with?

A
  • anti-diuretic hormone (ADH)
  • oxytocin
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18
Q

Name the stimulating hormone, that is released from the anterior pituitary gland, which targets the thyroid gland.

A

TSH (thyroid stimulating hormone)

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19
Q

Name the stimulating hormone, that is released from the anterior pituitary gland, which targets the adrenal cortex.

A

ACTH (adrenocorticotrophic hormone)

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20
Q

Name the stimulating hormone, that is released from the anterior pituitary gland, which targets and affects the whole body.

A

GH (growth hormone)

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21
Q

Name the stimulating hormones, that are released from the anterior pituitary gland, which effect cyclical rhythms in the reproductive tissues.

A
  • LH
  • FSH
  • Prolactin
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22
Q

What condition can develop from inadequate Anti-diuretic hormone (ADH) production?

A

Diabetes insipidus

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23
Q

What is the main characteristic of diabetes insipidus?

A

Passing lots of urine

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24
Q

What are the two main types of pituitary tumour?

A
  1. Functional adenoma
  2. Non-functional adenoma
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25
Q

What is a functional adenoma?

A

A tumour that produces an active hormone

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26
Q

What is a non-functional adenoma?

A

Tumour has no hormone secreting ability

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27
Q

How does a pituitary tumour lead to narrowing of an individuals visual field?

A

The tumour will grow and compress the optic chiasma, narrowing vision

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28
Q

What is trans-sphenoidal surgery?

A

A surgery performed through the nose and sphenoid sinus to remove pituitary tumours

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29
Q

What growth factor is often measured when looking at levels of growth hormone (GH)?

A

IGF-1

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30
Q

What is the function of IGF-1 in relation to growth hormone release?

A

It has a negative feedback on the pituitary gland to reduce growth hormone release

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31
Q

If a child has excess growth hormone, what condition will this result in?

A

Giantism

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32
Q

If an adult has excess growth hormone, what condition will this result in?

A

Acromegaly

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33
Q

What are the 6 dental signs of acromegaly?

A
  1. Change in occlusion
  2. spacing of teeth
  3. thickened lips
  4. Enlarged tongue
  5. “Shrunk dentures”
  6. Reverse overbite
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34
Q

What are the six general presenting features of acromegaly?

A
  1. Coarse features
  2. Enlarged supra-orbital ridges
  3. Broad nose
  4. Thickened lips
  5. Soft tissues
  6. Enlarged hands
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35
Q

What is carpal tunnel syndrome?

A

Where pressure on a nerve in your wrist causes pain and numbness in your hands and fingers

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36
Q

Why might an individual with acromegaly experience carpal tunnel syndrome?

A

Due to enlarged hand size

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37
Q

What other endocrine disorder is associated with acromegaly and why?

A

Type 2 diabetes mellitus, theres is insulin resistance from increased GH

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38
Q

Why might an individual with acromegaly develop cardiovascular disease?

A

Because the heart will have an increased role in dealing with increased body mass. The heart will also grow itself and become inefficient as a pump.

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39
Q

What is the term used to describe cardiac complications associated with acromegaly?

A

Acromegalic cardiomyopathy

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40
Q

What term is used to describe thyroid dysfunction in excess?

A

Hyperthyroidism

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41
Q

What term is used to describe thyroid deficiency?

A

Hypothyroidism

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42
Q

Are both hyperthyroidism and hypothyroidism usually primary or secondary in failure?

A

Primary (gland failure)

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43
Q

What is thyrotoxicosis?

A

“The clinical syndrome of excess circulating thyroid hormones “

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44
Q

What is another term for hypothyroidism?

A

Myxoedema

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45
Q

What are the four causes of hyperthyroidism?

A
  1. Graves’ disease
  2. Toxic multi-nodular goitre
  3. Toxic adenoma
  4. Pituitary tumour (rare)
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46
Q

What % of hyperthyroid cases are usually a cause of Graves’ disease?

A

70-80%

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47
Q

What is Graves’ disease?

A

An autoimmune disease that results in the overproduction of thyroid hormones, because auto-antibodies stimulate the TSH receptor to produce more hormones

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48
Q

What are the clinical signs of hyperthyroidism?

A
  • warm moist skin
  • tachycardia & atrial fibrillation
  • increased blood pressure & heart failure
  • tremor & hyperrefelxia
  • eyelid retraction & lid lag
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49
Q

What are symptoms of hyperthyroidism?

A
  • hot
  • excess sweating
  • weight loss
  • diarrhoea
  • palpitations
  • Muscle weakness
  • irritable
  • manic
  • anxious
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50
Q

What is a goitre?

A

Swelling of the thyroid gland (at the base of the neck)

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51
Q

What ophthalmology is associated with Graves’ disease?

A
  • Proptosis (where eyeballs are pushed froward in socket)
  • Peri-orbital oedema (swelling around eyes)
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52
Q

What is the most common cause of hypothyroidism, occurring in 90% of cases?

A

Autoimmune (Hashimoto’s) thyroiditis

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53
Q

What happens in Hashimoto’s disease?

A

Autoimmune thyroiditis is the most common cause. In this case, the antibody which is produced, attacks the thyroid gland itself and causes inflammation of the thyroid gland which causes gradual fibrosis and destruction of the specialised thyroid tissue

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54
Q

Along with Hashimoto’s disease, what are the other causes of primary hypothyroidism?

A
  • idiopathic atrophy
  • Radioiodine treatment/thyroidectomy surgery
  • iodine deficiency
  • drugs
  • congenital
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55
Q

What drugs are antagonistic to the thyroid gland and will reduce thyroid hormone secretion, causing hypothyroidism?

A
  • carbimazole
  • amiodarone
  • lithium
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56
Q

What are secondary causes of hypothyroidism?

A

-hypothalamic/pituiatry disease

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57
Q

What are the clinical signs of hypothyroidism?

A
  • dry coarse skin
  • bradycardia
  • hyperlipadaemia
  • psychiatric or confusion
  • goitre
  • delayed reflexes
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58
Q

What are the symptoms of hypothyroidism?

A
  • tired
  • cold intolerance
  • weight gain
  • constipation
  • hoarse voice
  • goitre
  • puffed face
  • angina
  • ‘slow’ poor memory
  • hair loss
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59
Q

What group of individuals is most commonly affected by hypothyroidism?

A

Middle aged and elderly Women

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60
Q

What are the presenting features of hashimotos thyroiditis?

A
  • goitre
  • hypothyroid features
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61
Q

When investigating thyroid disease, what three thyroid hormones can be measured through a blood test?

A
  • T3, T4 and TSH
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62
Q

What imaging/ tissue investigations can be used to investigate thyroid disease?

A
  • ultrasound scan (cysts)
  • radioisotope scans (gland uptake)
  • fine needle aspiration/biopsy
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63
Q

What will the levels of thyroid hormone be, in a case of hyperthyroidism with pituitary cause (rare)?

A
  • raised TSH
  • raised T3
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64
Q

What will the levels of thyroid hormone be, in a case of hyperthyroidism caused by Graves’ disease or adenoma? And why?

A

Low TSH
Raised T3

The pituitary gland recognises that there is too much hormone, tries to reduce gland stimulation by stopping production of TSH

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65
Q

What will the levels of thyroid hormones be, in a case of hypothyroidism with pituitary cause (rare)? And why?

A

Low TSH
Low T4

Pituitary gland is not seeking the thyroid gland to make thyroxine so the TSH and T4 are low

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66
Q

What will the levels of thyroid hormones be, in a case of hypothyroidism caused by gland failure? And why?

A

High TSH
Low T4

Thyroid gland cannot respond when it’s asked to make thyroid hormone by the pituitary, so the pituitary level of TSH is increased but still there is a low T4

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67
Q

What are the 4 treatment options for hyperthyroidism?

A
  • carbimazole
  • beta blockers (reduces side effects)
  • Radioiodine
  • surgery (partial thyroidectomy)
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68
Q

How does Radioiodine treat hyperthyroidism?

A

Radioiodine is taken up into the gland, the thyroid gland concentrates iodine to make the thyroid hormones and if this is radioactive, the iodine will decay with time, releasing particles which will damage and kill off cells reducing the bulk of thyroid tissues and bringing the patient back to a normal thyroid level.

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69
Q

What is the treatment option for hypothyroidism?

A

Thyroxine tablets (T4)

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70
Q

What feature would be indicative of thyroid cancer on a radioisotope scan?

A

“Cold” nodules

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71
Q

What are the two types of thyroid cancer?

A
  • papillary
  • follicular
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72
Q

Where are the adrenal glands located?

A

They sit on the kidneys

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73
Q

What is Addisons disease?

A

Where adrenal tissue is destroyed and no hormones can be produced

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74
Q

What disease is characterised by excess adrenal action?

A

Cushings disease

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75
Q

What class of hormones is produced in the adrenal cortex?

A

Corticosteroids

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76
Q

What are the three histological areas of the adrenal gland?

A
  1. Zona glomerulosa
  2. Zona fasicularis
  3. Zona reticularis
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77
Q

What hormone is produced in the Zona glomerulosa of the adrenal gland?

A

Aldesterone

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78
Q

What hormone is produced in the Zona fasicularis of the adrenal gland?

A

Cortisol

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79
Q

What hormone is produced in the Zona reticularis of the adrenal gland?

A

Adrenal androgens (male sex hormones)

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80
Q

What hormone does the hypothalamus release in adrenal regulation?

A

Cortico-trophic releasing hormone (CRH)

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81
Q

In adrenal regulation, What hormone is released from the anterior pituitary gland upon stimulation by CRH?

A

ACTH

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82
Q

In what location of the adrenal gland does ACTH target, and what hormone is secreted as a result?

A

Adrenal cortex & cortisol

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83
Q

What system controls aldesterone?

A

Renin-angiotensin system

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84
Q

What is the function of aldosterone?

A

Salt and water regulation

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85
Q

What two drug groups can inhibit the action of aldosterone?

A
  • ACE inhibitors
  • AT2 blockers
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86
Q

What are the main side effects of taking ACE inhibitors?

A
  • cough
  • angio-oedema
  • oral lichenoid drug reactions
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87
Q

How do AT2 blockers inhibit action of aldosterone?

A

By blocking angiotensin receptor

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88
Q

How does cortisol raise blood pressure?

A

By enhancing salt and water reabsorption

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89
Q

How could high levels of cortisol lead to osteoperosis in the long term?

A

Because cortisol inhibits bone synthesis and in doing so reduces bone turnover

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90
Q

What are the 4 physiological steroid effects of cortisol?

A
  • antagonist to insulin
  • lowers the immune reactivity
  • raises blood pressure
  • inhibits bone synthesis
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91
Q

Give five examples of therapeutic steroids

A
  1. Hydrocortisone
  2. Prednisolone
  3. Trimcinolone
  4. Dexamethasone
  5. Betamethasone
92
Q

How many more times potent is prednisolone’s effect compared to cortisol?

A

4x more

93
Q

What therapeutic steroid is used in the managment of oral mucosal inflammation?

A

Betamethasone

94
Q

What two enhanced effects can result from therapeutic steroid use?

A
  • glucocorticoid effects
  • mineralcorticoid effects
95
Q

What are the consequences of an enhanced glucocorticoid effect?

A
  • immunosupression and reduced inflammatory response
96
Q

What is the consequence of an enhanced mineralcorticoid effect?

A

Salt and water retention which can lead to hypertension

97
Q

What syndrome is caused as a result of excess glucocorticoid production?

A

Cushing’s syndrome

98
Q

What syndrome is caused as a result of excess aldosterone production?

A

Conn’s Syndrome

99
Q

What is the most common cause of an excess production of aldosterone?

A

An adrenal tumour

100
Q

What is the primary cause of an excess production of glucocorticoid?

A

An adrenal tumour

101
Q

What is the secondary cause of an excess production of glucocorticoid?

A

A pituitary tumour causes excess ACTH production

102
Q

What is the primary cause of hypofunction of the adrenal gland?

A

Addisons disease

103
Q

What is the secondary cause of hypofunction of the adrenal gland?

A

Pituitary failure

104
Q

What is the difference between Cushing’s syndrome and cushings disease?

A

Cushings disease is a type of Cushing’s syndrome. Cushing’s syndrome = medication or problem with adrenal gland leading to systemic changes
Cushings disease = pituitary tumour causes excess ACTH production which causes excess glucocorticoid excretion

105
Q

What are the main symptoms associated with Cushing’s syndrome?

A
  • diabetes mellitus features
  • poor resistance to infections
  • back pain and bone fractures
  • psychiatric disorders
  • hirsuitism (excess hair)
  • skin and mucosal pigmentation
  • infertility
106
Q

What symptom of Cushing’s syndrome occurs as a result of high ACTH levels?

A

Skin and mucosal pigmentation.

Skin = especially over joints
Mucosa = generalised patchy brown pigment

107
Q

What are the clinical signs of Cushing’s syndrome?

A
  • centripetal obesity ( in face, neck and trunk)
  • moon face
  • buffalo hump
  • hypertension
  • thin skin and purpura
  • muscle weakness
    -osteoporotic changes and fractures
108
Q

What is the most common cause of adrenal hypofunction?

A

Gland failure

109
Q

In what three ways can adrenal gland failure occur?

A
  • autoimmune gland destruction
  • infection
  • infarction
110
Q

In what situation could Sheehan’s syndrome occur?

A

When the anterior pituitary gland is damaged due to significant blood loss.

111
Q

What is autoimmune adrenalitis?

A

An autoimmune disease where your immune system attacks your adrenal glands

112
Q

What are the clinical signs of Addisons disease?

A
  • postural hypotension
  • weight loss and lethargy
  • hyperpigmentation
  • vitiligo
113
Q

What are the symptoms of Addisons disease?

A
  • weakness
  • anorexia
  • loss of body hair
114
Q

In what situation would hyperpigmentation not be a sign of Addisons disease?

A

If adrenal failure is secondary and due to pituitary failure. In this case there will not be a high ACTH level.

115
Q

How are cortisol levels measured for an individual with Cushing’s syndrome?

A

Urinary cortisol excretions over 24 hours

116
Q

If a patient has high cortisol levels, what medication should they be given to suppress these levels?

A

High potency corticosteroids

117
Q

What will the levels of ACTH and cortisol be if there is hyperfunction of the adrenal gland due to either pituitary adenoma or ectopic ACTH production?

A

High ACTH
High cortisol

118
Q

What will the levels of ACTH and cortisol be if there is hyperfunction of the adrenal gland due to gland adenoma?

A

Low ACTH
High cortisol

119
Q

What will the levels of ACTH and cortisol be if there is hypofunction of the adrenal gland due to pituitary failure?

A

Low ACTH
Low cortisol

120
Q

What will the levels of ACTH and cortisol be if there is hypofunction of the adrenal gland due to gland destruction?

A

High ACTH
Low cortisol

121
Q

What investigative test is used for Addisons disease?

A

SynACTHen test

122
Q

What response to a synACThen test would suggest adrenal gland failure?

A

Negative

123
Q

What will the response to a synACTHen test be if there is hypofunction of the adrenal gland due to pituitary failure?

A

Positive

124
Q

What will the response to a synACTHen test be if there is hypofunction of the adrenal gland due to gland destruction?

A

Negative

125
Q

What is Hypovolemic shock?

A

A medical emergency where there is severe blood or other fluid loss which makes the heart unable to pump enough blood to the body which stops organs from working

126
Q

What is hyponatremia?

A

Sodium level in the blood are low

127
Q

What is adenosian crisis and why does it happen?

A

Life-threatening condition resulting in hypertension and vomiting from hyponatraemia. This can occur if Addisons disease is left untreated, it can lead to a coma.

128
Q

What are the two hormone replacement drugs to manage Addisons disease?

A
  • cortisol
  • fludrocortisone
129
Q

Name a drug replacement for aldosterone?

A

Fludrocortisone

130
Q

What is the purpose of Fludrocortisone?

A

It maintains salt and water balance

131
Q

What two factors require there to be an increase in cortisol dose given?

A
  • physical/psychological stress
  • infection
132
Q

In what three cases should a patient with Addisons disease increase their steroid dose?

A
  1. If they have an infection
  2. If they are to have any type of surgery
  3. Physiological stress
133
Q

From a dental perspective, what might an individual with high cortisol levels develop?

A

Oral opportunistic infections, such as oral candidiasis/acute thrush

134
Q

What oral infection is associated with cushings syndrome?

A

Candidiasis

135
Q

What two adrenal diseases may be indicated by oral pigmentation?

A
  • Addisons disease
  • Cushing’s syndrome
136
Q

What endocrine disease is characterised by an abnormality in glucose regulation?

A

Diabetes mellitus

137
Q

What endocrine disease is characterised by an abnormality of renal function?

A

Diabetes insipidus

138
Q

What is the most common type of diabetes?

A

Diabetes type 2 (85%)

139
Q

what is the major characteristic of diabetes mellitus?

A

Hyperglycaemia

140
Q

What test can be used to establish the diagnosis of diabetes mellitus?

A

A glucose tolerance test

141
Q

What are the intermediate zones between normal and overt diabetes termed? And what are they indicative of?

A

Pre-diabetes.
They are strong indicators of future diabetes development

142
Q

What are the 4 tests for diabetes mellitus?

A
  1. Random plasma glucose (RPG) test
  2. Fasting sugar test
  3. Glucose tolerance test (GTT)
  4. HbA1C (glycosolated haemoglobin) test
143
Q

What type of diabetes test is this?

“A glucose test on the blood of a non-fasting person. This test assumes a recent meal.”

A

Random plasma glucose (RPG) test

144
Q

What type of diabetes test is this?

Where the patient does not intake sugar overnight before having taking the test

A

Fasting sugar test

145
Q

What type of diabetes test is this?

Where a fixed glucose load is given to the patient and the sugar level assessed afterwards

A

Glucose tolerance test (GTT)

146
Q

What type of diabetes test is this?

“Measures amount of blood sugar (glucose) attached to haemoglobin”

A

HbA1C test

147
Q

What type of diabetes test is used to monitor diabetes?

A

HbA1C test

148
Q

When is a glucose tolerance test indicated?

A

If fasting sugar test indicates impaired fasting glucose

149
Q

From a random plasma glucose test, what measurement of plasma glucose on 2 occasions is diagnostic of diabetes?

A

> 11.1mmol/L

150
Q

What is considered to be a normal hbA1C target for an individual?

A

<48mmol/mol (6.5%)

(Levels of 6.5% or higher indicate diabetes)

151
Q

As part of glucose tolerance testing, what should the measurement of glucose concentration be before the test takes place? ( for indications of normal, impaired fasting glucose, and diabetes)

A

Normal = FPG <6.1mmol/L
IFG = FPG 6.1-7.0 mmol/L
Diabetes = FPG >7.0 mmol/L

152
Q

What does it mean when someone has impaired fasting glucose?

A

When glucose levels are raised but not high enough to indicate diabetes

153
Q

As part of glucose tolerance testing, what should the measurement of glucose concentration be 2 hours after plasma glucose load? (for indications of normal, impaired fasting glucose, and diabetes)

A

Normal = <7.8 mmol/L
IGT = 7.8-11.1 mmol/L
Diabetes = >11.1 mmol/L

154
Q

Which type of diabetes mellitus is characterised by insulin deficiency?

A

Type 1

155
Q

What causes type 1 diabetes mellitus?

A

Autoimmune destruction of pancreatic B cells

156
Q

What determines the clinical presentation of type 1 diabetes mellitus?

A

The rate at which the pancreatic B cells are destroyed

157
Q

What are the two consequences of immune mediated pancreatic B cell destruction in type 1 diabetes?

A
  • hyperglycaemia
  • ketoacidosis
158
Q

Low levels of what peptide indicate low insulin secretion?

A

C-peptide

159
Q

What are the circulating antibodies present in type 1 diabetes?

A
  • Glutamic acid decarboxylase (GAD)
  • islet cell antibodies (ICA)
  • insulin autoantibodies (IAA)
160
Q

Why can a type 1 diabetic present with ketoacidosis?

A

Patient will usually be metabolising fat within cells rather than glucose, in order to maintain cell energy. This will result in production of ketones which are inherently acidic.

161
Q

What are the two islet autoantibodies, which an increase in would indicate type 1 diabetes in children/adolescents?

A

ICA and IAA

162
Q

What is meant by LADA?

A

Latent autoimmune diabetes of adults

163
Q

What circulating antibody is associated with LADA?

A

Glutamic acid decarboxylase (GAD)

164
Q

What is meant by polyuria?

A

Passing of lost of urine

165
Q

What is meant by polydipsia?

A

Excessive thirst

166
Q

What are the three main symptoms of diabetes type 1?

A
  • polyuria
  • polydipsia
  • tiredness
167
Q

What type of diabetes is strongly associated with obesity and inactivity?

A

Diabetes type 2

168
Q

What is MODY?

A

Maturity onset diabetes in the young, is a type of monogenic diabetes, caused by gene mutation, presenting in non-obese children and adolescents

169
Q

What type of diabetes is characterised by defective and delayed insulin secretion and abnormal postprandial suppression of glucagon?

A

Type 2 diabetes mellitus

170
Q

What surgery, for obese individuals, has shown promising results in terms of remission of type 2 diabetes?

A

Bariatric surgery

171
Q

Name a medication, that if used for a long time can cause hyperglycaemia and lead to development of diabetes?

A

Steroids

172
Q

What are the two key targets for insulin secretion?

A

Portal vein and liver

173
Q

What type of diabetes has a gradual onset and what type has a fast onset?

A

Gradual = type 2
Fast = type 1

174
Q

What types of medication can induce diabetes? Name 5 groups of medication.

A
  • corticosteroids
  • immune suppressants (e.g. cyclosporine)
  • cancer medication ( e.g. imatinib)
  • antipsychotics (e.g. clozapine)
  • antivirals (e.g. protease inhibitors)
175
Q

What other endocrine diseases is diabetes type 2 related to?

A
  • Cushing’s disease
  • Phaeochromocytoma (adrenaline tumour)
  • acromegaly
176
Q

What are the risk factors for gestational diabetes?

A
  • overweight
  • family history of diabetes
  • Asian, Afro-Caribbean and Middle Eastern ethnicity
  • gestational diabetes in previous pregnancy
177
Q

In diabetes management, what is the preprandial (before food) target for blood glucose levels?

A

4-6 mmol/L

178
Q

In diabetes management, what is the bedtime target for blood glucose levels?

A

6-8 mmol/L

179
Q

When is insulin used in the management of type 1 diabetes?

A

From diagnosis

180
Q

When is insulin used in the management of type 2 diabetes?

A

Used when there is inadequate control of blood sugar on oral meds

181
Q

What are the two types of insulin regimes used for management of diabetes?

A
  1. Basal-bolus more injections
  2. Split-mixed fewer injections
182
Q

What is a basal-bolus injection?

A

A single long lasting insulin which provides enough insulin for the whole day to prevent ketoacidosis

183
Q

What is a split- mixed fewer injection?

A

Fewer injections needed, patient may only have two injections of insulin in a day before meals. This insulin contains both rapid acting and medium acting insulin so that blood sugar is maintained.

184
Q

Which type of insulin regime has better control, basal bolus more injections or split-mixed fewer injections?

A

Basal bolus more injections

185
Q

Which type of insulin regime has poorer control but a more practical delivery, basal bolus more injections or split-mixed fewer injections?

A

Split-mixed fewer injections

186
Q

Why does a patient tend to change/ rotate their site of insulin injection?

A

Can lead to fat atrophy in one site if constantly used

187
Q

What are the 4 key factors to diabetes management?

A
  • structured education
  • healthy living advice
  • blood glucose management
  • prevention to reduce risk of
188
Q

What medications can be used as a preventative measures for diabetes to reduce risk?

A
  • antiplatelet drugs
  • statins
  • anti-hypertensives
189
Q

A type 1 diabetic should receive what % of calories from saturated fat?

A

10%

190
Q

What is meant by glycaemic index?

A

The equivalent of the glucose load provided by that food

191
Q

What is the aim for sugar levels in a type 1 diabetic?

A

6-10%, with ideally a lower end score being recorded most of the time.

192
Q

What are the two types ofT1DM insulin monitoring options?

A
  • continuous glucose monitoring
  • closed loop glucose monitoring
193
Q

What is involved in continuous glucose monitoring?

A

this is a device that attaches to the skin, and has a small needle which monitors the tissue fluid glucose levels subcutaneously, it will then relay this to a monitor and the patient will then get an alert if their blood sugar exceeds the target range.

194
Q

What is involved in closed loop glucose monitoring?

A

The monitor is attached to an insulin pump which will change the amount of insulin delivered to the body in a continues way in response to the subcutaneous sugar level.

195
Q

How should a T2DM patient restrict their diet?

A
  • avoid refined CHO
  • encourage high fibre food
  • reduce saturated fat intake
196
Q

What is the first line drug used to treat T2DM?

A

Metformin

197
Q

What are the two main functions of Metformin in the treatment of T2DM?

A
  1. Enhance cell insulin sensitivity
  2. Reduce hepatic gluconeogenesis
198
Q

Name three other medications, second line to Metformin, that can be used in the management of T2DM?

A
  • DDP-4 inhibitors (Gliptins)
  • GLP-1 mimetics
  • sulphonylureas
199
Q

What are the functions of DDP-4 inhibitors in the treatment of T2DM?

A
  • They block enzymes that metabolise incretins (Incretins stimulate insulin release)
  • improve insulin response to glucose
  • reduce liver gluconeogenisis and delay stomach emptying
200
Q

What is the function of GLP-1 mimetics in the treatment of T2DM?

A

The increase the level of incretin

201
Q

What is the function of sulphonylureas in the treatment of T2DM?

A

They increase pancreatic insulin secretion

202
Q

What T2DM medication can cause hypoglycaemia? And how?

A

Sulphonylureas, they lower blood glucose by stimulating insulin release from pancreatic beta cells.

203
Q

When can acute hypoglycaemia occur in a T1DM patient?

A

When there is a mismatch between the amount of insulin and the amount of sugar available. I.e. if the patient injects insulin but fails to have an adequate meal then they will become hypoglycaemic.

204
Q

When can acute hypoglyceamia occur in T2DM patients?

A

If they take sulphonylureas or insulin

205
Q

What are three complications of chronic diabetes? And state whether they are due to macrovascular or micro vascular changes to blood vessels.

A
  • CV risk (macro-vascular)
  • infection risk (micro-vascular)
  • neuropathy (micro-vascular)
206
Q

What type of DM is most commonly associated with hypoglycaemic attacks?

A

T1DM

207
Q

What are examples of large vessel complications of diabetes?

A
  • angina
  • MI
  • claudication
  • aneurysm
208
Q

What are examples of small vessel complications of diabetes?

A
  • poor wound healing
  • easy wound infections
  • renal disease
  • eye disease
  • neuropathy
209
Q

What can be the conscience of neuropathy in peripheral tissues of hands and feet when patient without DM has poor wound healing.

A

Tissues become necrotic and amputation is required

210
Q

What are the three types of eye disease associated with diabetes?

A
  • cataracts
  • maculopathy
  • proliferative retinopathy
211
Q

What is meant by maculopathy?

A

Where you lose high density cone section of the retina and therefore lose detailed vision

212
Q

What is meant by proliferative retinopathy?

A

Where blood vessels will grow across the back of the retina, these may then burst leading to haemorrhage over back of the retina and gradually obliteration of the visual part of the eye.

213
Q

What sort of vision will a patient with cataracts have?

A

Blurry vision

214
Q

What is the characteristic appearance of cataracts?

A

White opacity within the iris

215
Q

What treatment is available for diabetic retinopathy?

A

Laser therapy

216
Q

What is general sensation of diabetic neuropathy normally termed as?

A

Glove and stocking numbness

217
Q

What is motor neuropathy?

A

Weakness and wasting of muscles

218
Q

What is needed to prevent ketosis in T1DM?

A

Insulin

219
Q

What is needed to prevent hypoglycaemia in T1DM?

A

Carbohydrate

220
Q

What are the 5 metabolic changes associated with surgery in a diabetic?

A
  • hormone changes aggravate diabetes
  • more glucose production and less muscle uptake
  • metabolic acidosis more likely
  • increased insulin requirements for T1DM
  • T2DM may require insulin cover before surgery
221
Q

What are the 4 dental aspects that need to be considered for someone with diabetes?

A
  • acute emergency
  • diabetic complications
  • infection risk
  • poor wound healing
222
Q

Why does someone with Addisons disease have low blood pressure?

A

Deficiency of aldosterone hinders kidneys ability to filter salt and water, resulting in low BP.

223
Q

What consideration are there for future dental treatment of an individual with Addisons disease?

A
  • steroid prophylaxis if surgery required or has infection
224
Q

How can a corticosteroid such as prednisolone cause secondary adrenal insufficiency?

A

It can flatten the function of the adrenal gland so that it does not produce natural steroids

225
Q

What can happen to tooth roots in an individual with acromegaly?

A

Can get hypercementosis on roots so they become very bulbous. This can cause issues for extraction.

226
Q

How would you manage an individual experiencing ketoacidosis?

A

Call 999 (they need to be in hospital on an insulin pump and fluids)

227
Q

What does HbA1c measure?

A

Cumulative blood glucose in the preceding 3 months

Dentistry Human Disease (29 decks)

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