Lecture 4- Endocrine & Metabolic disease Flashcards
The hormones of the adrenal cortex are to maintain:
BP
Related to lack of beta cell pancreatic production of insulin:
DM
Up to 90% of DM cases are:
Type II
For those that are pregnant, there is a 2-10% risk of getting:
Gestational diabtetes
For a pregnant patient who gets diabetes, they are at an increased risk of _____ in the future
Type II DM
Insulin is needed for _____ into cells
sugar absorption
A lack of insulin leads to increased _____ aka ____
serum glucose; hyperglycemia
What does hyperglycemia result in? (think tissues)
Results in undernourished tissues
What is responsible for producing insulin?
Beta cells of pancreas
T/F: You can get Type 1 DN at the age of 64
True
How many people are type 1 diabetics?
10-20% of diabetics are Type 1
Insulin dependent-
Type 1
Type 1 diabetes is considered a ___ disease
autoimmune
In Type 1 diabetes what leads to the insulin deficiency?
Destruction of pancreatic beta cells (insulin producing cells)
Type 1 diabetes onset is broken down into 3 stages. Which stages are symptomatic and which are symptomatic?
Stage 1&2: asymptomatic
Stage 3: symptomatic
Describe how diabetes presents at the MICROVASCULAR level:
- neuropathy
- retinopathy
- nephropathy
(microvascular = opathy(s))
Where are some areas that diabetics can experience neuropathy:
- extremeties
- bladder
- gastroparesis
- impotence
Describe the effects of retinopathy:
- cataracts
- blindndess
Describe how diabetes presents at the MACROVASCULAR level:
- peripheral vascular disease
- CHF
- HTN
- MI
- Stroke
Why might see a diabetic patient having an increased risk for MI?
Diabetes accelerates atherosclerosis
Describe diabetes affects on the bodies ability to heal itself:
DM causes impaired wound healing & susceptibility to infection
Diabetic patients release ____ which breaks down soft tissue and contribute to the impaired wound healing ability seen in these patients
collagenase
Reasons why diabetics struggle with wound healing:
- release of collagenase
- neutrophil dysfunction
- increased pro-inflammatory cytokines
- increase MMPs (metal metalloproteinase)
- impaired angiogenesis
- endothelial dysfunction
Type 2 diabetes may also be referred to as:
- adult onset
- non-insulin dependent
In this disease the pancreas produces insulin but it is low in titers or it does not work properly:
Type 2 DM
What percentage of diabetics are type 2?
80-90%
Fasting plasma glucose level:
normal:
pre-DM
Type 2 DM:
normal: <100 mg/dl
pre-DM: 100-125 mg/dl
Type 2 DM: 126+
For oral glucose tolerance test (2hr plasma glucose):
normal:
pre-DM:
Type 2 DM:
normal: <140 mg/dl
pre-DM: 140-199 mg/dl
Type 2 DM: 200+ mg/dl
HgA1C:
normal:
pre-DM:
Type 2 DM:
normal: <5.7%
pre-DM: 5.7-6.4%
Type 2 DM: 6.5%+
Random glucose in patients with Type 2 DM:
> 200 mg/dl in patients with symptoms
Measures the glycosylaton of HbA (the protein than connects hemoglobin A where the glucose is attaching to):
A1C
If there is too much glucose in the blood stream, it attaches itself to ___ on the ____
hemaglobin; RBCs
A stable measure not affected by QD glucose fluctuation:
A1C
An HBA1c measures the amount of:
gylcosylation
Higher prevalences of ______ in poorly controlled diabetics
severe periodontal disease
T/F: According to a study, short-term reduction in HbA1C levels at 3-4 months after periodontal intervention occurred, but there was not long term studies
True
T/F: There is a correlation between the severity of periodontitis and the severity of retinopathy
True
If someone has periodontitis + diabetes, this puts then at risk for more ____ & _____ complications
renal & cardiovascular
All of the diabetic drugs work to:
lower sugar in the blood stream one way or another
List the mechanism of the following diabetic drugs:
-Biguanide (metformine)
-insulin (rapid, short, LL)
Decrease in gluconeogenesis
List the mechanism of the following diabetic drugs:
-Sulfonylureas (Glipizode, Chlorpropamide, Tolbutamide)
-Glucagon-like peptide 1 (GLP1) receptor agonist (Exenatide, Liraglutide)
Increase insulin secretion
List the mechanism of the following diabetic drugs:
-Thiazolidinediones (pioglitazone)
Sensitization to insulin
List the mechanism of the following diabetic drugs:
-Dipeptidyl peptidase 4 (DPP4) (sitagliptin)
-GLP1 receptor agonist (Exenatide, Liraglutide)
Decrease in glucagon secretion
List the mechanism of the following diabetic drugs:
-Sodium-glucose co-transporter-2-inhibitors (Canagliflozin)
-Alpha-glucoside inhibitor (Acarbose)
Intestinal & renal absorption of glucose
If the body is not getting enough sugar, then it goes to the bodies reserves to get sugar, and it breaks down cholesterol & fats into glucose to provide glucose to the bloodstream, but there already is glucose in the bloodstream its just not being taken up properly.
A medication that slows down the biofeedback mechanism that the body is telling itself if needs more sugar from the stores even though there is sugar in the bloodstream. What medication is this?
Metformin
What are some of the oral manifestation of diabetes:
- xerostomia
- oral burning (not burning mouth syndrome, secondary)
- infections (bacterial, FUNGAL, viral)
- poor wound healing
- increased caries
- increased severity of periodontal risk
One way to tell if a diabetic patient has control or not is by:
Fungal infection in the oral cavity
(everyone has Candida albicans in their oral cavity but this becomes opportunistic in diabetic patients often causing infection)
Fasting glucose (or 2hrs post meal) = less than 70 or greater than 200
HbA1C= >8.0%
As a dentist you should:
- DEFER elective treatment
- If emergency, consider referral to hospital/specialized setting
- send medical consult
Fasting glucose (or 2hrs post meal) = less than 70 or greater than 200
HbA1C= >8.0%
Discuss prophylactic antibiotics for this patient:
Context-dependent
With diabetes, control of comorbities & drug interactions includes:
- HTN
- HLP
- Other CVD (angina, MI, CHF)
- Renal impairment
What antibiotics/drugs should be AVOIDED in patients with diabetes?
- Tetracyclines (including Doxycycline)- hypoglycemia
- Fluoroquinolones (Cipro, Levo, Leva) - hypoglycemia
- Aspirin with sulfonylureas - hypoglycemia
Many antibiotics should be avoided with diabetics patients that are specifically on ____ because this may cause _____
insulin; hypoglycemia
-tetracycline
-doxycycline
-ciprofloxacin
-levofloxacin
-levaquin
-(fluoroquinolone)
For a diabetic patient, aspirin with ____ should be avoided if they are taking insulin due to risk of _____
sulfonylureas; hypoglycemia
In patients with diabetes, be aware that sulfonylureas may cause:
thrombocytopenia
What medication may be responsible for thrombocytopenia in diabetic patients?
Sulfonylureas
What timing of appointments is best suited for diabetic patients?
Early morning
Describe how diabetic patients should prepare for a morning appointment:
Eat normal meal and take medications prior to appointment
As a dental provider, when treating a diabetic patient you should be away of and have your patient communicate _______.
In addition, have _____ readily available
Symptoms of hypoglycemia; high-concentration sugar products (orange juice, cake icing, soft drinks)
____ is not recommended for diabetics as fasting is necessary
oral sedation
In what term does gestational diabetes typically present in a pregnant patient?
Presents at mid term - 24-28 weeks
between second & third trimester
The ovaries are responsible for releasing:
estrogens & progesterone