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CSA > systemic risk factors part 2 > Flashcards

systemic risk factors part 2 Flashcards

1
Q

what is the definition of diabetes

A

common group of metabolic disorders characterised by chronic hyperglycaemia resulting from insulin deficiency or impaired utilisation of insulin

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2
Q

what is diabetes characterised by

A

chronic hyperglycaemia

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3
Q

what does chronic hyperglycaemia result from

A

insulin deficiency or impaired utilisation of insulin

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4
Q

what is the full name of diabetes

A

diabetes mellitus

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5
Q

what can the medication of diabetes result in

A

hypOglycaemia

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6
Q

in 2017 what did the international’s federation of diabetes find out to be the number of people suffering worldwide

A

451 million ( aged 18-99 years)

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7
Q

what is the expected number of people suffering from diabetes in 2045

A

693 million

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8
Q

how many people were diagnosed with diabetes in 2018 in the uK

A

3.7 million

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9
Q

how many people are at an increased risk of type 2 diabetes

A

12.3 million

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10
Q

what percentage of people have type 1 diabetes in the uk

A

10%

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11
Q

what percentage of people have type 2 diabetes in the uk

A

90%

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12
Q

what is the % of gestational diabetes

A

3.5%

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13
Q

what type of diabetes can we get in young adults

A

1-2%

MATURITY ONSET DIABETES

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14
Q

how many people are estimated to be undiagnosed with mainly type 2

A

1 million

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15
Q

describe type 1 diabetes

A

destruction of b cells in the islets of Langerhans in the pancreas
autoimmune disease
generic disposition
abrupt onset, most often in children or teens

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16
Q

describe type 2 diabetes

A

defect in b cells and is insulin resistant
usually manifests mid life and less children affected
genetic influence
increased risk if sedentary lifestyle, obese, asian/afro Caribbean
complications possible

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17
Q

what is the typical age group for type 1 diabetes

A

abrupt onset, most often in children or teens

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18
Q

what is the typical age group for type 2 diabetes

A

mid life but now can be seen in younger ages

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19
Q

what are the risk factors for type 2 diabetes

A

Sedentary lifestyle, obese, asian/afro carribean

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20
Q

how can we test for diabetes

A

venous plasma glucose levels
HbA1c- OVER A PERIOD OF TIME
glucometer can be done at home

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21
Q

what does the random venous plasma glucose levels have to be

A

greater than or equal to 11.1 mmol per litre

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22
Q

what does the fasted venous plasma glucose levels have to be

A

greater than 7 mmol per litre AND
unexplained weight loss
polyuria
polydipsia

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23
Q

what is polyuria

A

a condition usually defined as excessive or abnormally large production or passage of urine (greater than 2.5 or 3 L over 24 hours in adults)

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24
Q

what is polydipsia

A

abnormally great thirst as a symptom of disease (such as diabetes) or psychological disturbance.abnormally great thirst as a symptom of disease (such as diabetes) or psychological disturbance.

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25
Q

what should normal blood glucose levels be

A

4-5.5 mmol per litre before meals
OR
less than 8 mmol per litre 2 hours after meal

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26
Q

How do we use HbA1c To test for diabetes

A

glucose binds to haemoglobin within erythrocytes for the life of the RBC( 8-12 wks)
we measure how much haemoglobin is glycated

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27
Q

what is the cut off point for HbA1C

A

48 mmol per mol (6.5%)

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28
Q

what should we try to keep diabetes in the range of in regards to HbA1C according to the new system

A

6.5-7.5%

AKA 48-58mmol/mol

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29
Q

what should we try to keep non diabetic people in the range of according to the new system

A

4-6%

20-42 mmol/mol

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30
Q

what are the implications of poorly controlled diabetes

A

diabetes complication

risk factor for perio diseases

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31
Q

how can we treat type 1 diabetes

A

insulin injections/pump
balance carb intake and insulin
new technology includes transplantation of islets of langerhans cells in the pancreas

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32
Q

how do we treat type 2 diabetes

A

treat by diet or oral hypoglycaemia drugs and exercise
25% may need insulin injections
balancing act

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33
Q

how do we carry out a home glucose monitor

A

simple finger prick
drop of blood on a strip
inserted into a glucometer

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34
Q

what do we aim for on a home glucose strip

A

4-7 mmol per litre

under the renal threshold of 10 mmol per litre

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35
Q

what is the new technology for home glucose monitoring

A

flash glucose sensor

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36
Q

what are the complications of diabetes

A

macrovascular

microvascular

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37
Q

what are the macrovascular complications of diabetes

A

CVD( major cause of death) and peripheral vascular disease- amputations
cerebrovascular disease and stroke

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38
Q

what are the microvascular complications of diabetes

A

retinopathy- blindness
neuropathy- painful nerve damage
nephropathy- kidney failure

39
Q

what was the percentage of type 1 diabetics who achieved the target percentage in 2016-2017

A

30.2%

40
Q

what was the percentage of type 2 diabetics who achieved the target percentage in 2016-2017

A

66.8%

41
Q

what is the target percentage for diabetics

A

less than 7.5%

42
Q

what does diabetics cost the nHS

A

23.7 BILLION in uk

43
Q

how much do diabetic patients take of the NHS budget

A

10%

44
Q

what percentage of hospital beds to diabetics take up

A

19%

45
Q

what level will people start expiring hyocylcaemic effects

A

under 4mmol per litre

46
Q

what is the projected cost for diabetes in 2035/2036

A

39.8 billion

47
Q

what do studies show

A

that people with poorly controlled diabetes had more attachment bone loss and bone

48
Q

what is there an increase risk of in the study

A

of perio disease with age

increased severity with the duration of diabetes

49
Q

what do Pima indians have a higher prevalence of

A

type 2 diabetes

50
Q

what is the increased risk of Loss of attachment in pima indians

A

2.8 x

51
Q

what is the increased risk of bone loss n pima indians

A

3.4 x

52
Q

what is the risk of mortality in pima indians

A

3.2 x

due to ischaemic heart disease and nephropathy

53
Q

what is the central feature of pathogenesis of DM and periodontitis

A

inflammation

54
Q

what can cause systemic inflammatory response

A

perio infections

55
Q

what is there an increase of in systemic inflammation

A

acute phase proteins such as C reactive protein

and pro inflammatory cytokines

56
Q

give an example of acute phase protein

A

C reactive protein

57
Q

what is stimulated in obesity

A

IL-6 stimulates TNF-alpha

58
Q

what molecule stimulatied TNF- alpha

A

IL-6

59
Q

what does an increase in TNF- alpha and IL-6 may cause

A

insulin resistance- in type 2 diabetes

60
Q

what might an increase in IL-B cause

A

pancreatic ß cell destruction- in type 1 diabetes

61
Q

what is AGE

A

advanced glycation end products

62
Q

how do we get AGE

A

from hyperglycaemia which leads to collagen undergoing non enzymatic glycation

63
Q

what changes occur which leads to AGE forms

A

increased crosslinking- negative cross links

increased cytokine production

64
Q

what occurs after increased cytokine production

A

microvascular complications
atherosclerosis
decreased production of bone matrix

65
Q

what is RAGE

A

RECEPTOR FOR AGES

66
Q

What activates the RAGES

A

ages

67
Q

what happens when RAGES and AGES interact

A

Microvascular & macrovascular diabetes complications

Accelerated periodontal tissue destruction

68
Q

what is linked to LOA

A

BMI which is related to obesity

69
Q

what happens to PMN in diabetes mellitus

A

reduced PNM—> increased perio
enhanced resp burst
and delayed apoptosis and increased tissue destruction

70
Q

what do systematic reviews currently tell us about perio diseases and diabetes control

A

periodontal diseases adversely affect diabetes outcomes:

71
Q

with less HbA1C there is a reduced risk of

A

Deaths related to diabetes, 21%
Myocardial infarction, 14%
Microvascular complications,

72
Q

what is the reduced % of deaths related to diabetes when less Hb1AC

A

21%

73
Q

what is the reduced % of myocardial infarction when less Hb1AC

A

14%

74
Q

what is the reduced % of microvascular complications when less Hb1AC

A

37%

75
Q

what do we advise for perio care in diabetics

A

1.Check HbA1c with Diabetes Care Team
Follow principles of 3 stages of therapy
2.Initial therapy: GDP can undertake; if poor response, consider specialist referral
3.Corrective therapy: Consider adjunctive systemic antibiotics (but more research needed)
4.Supportive therapy: GDP can undertake

76
Q

how do we manage hypoglycaemia

A

Give 3-6 glucose tablets (3g each) ie 10-20g
give glucose drink eg Lucozade 150-200ml
buccal glucose- less cooperative patient

77
Q

what are the clinical symptoms of hypoglycaemia

A

Pale, shaky, clammy, may be aggressive/confused; blood glucose <4 mmol/l

78
Q

how do we manage severe hypoglycaemia

A

Give glucagon IM, SC or IV injection (
Advice: get doctor/dial 999 if no recovery in 10 minutes
If still unconscious, will need glucose IV

79
Q

what mgram of glucagon do we give if they are adult or over 8 years

A

1mg

80
Q

what amount of glucagon do we give if the child is under 8

A

0.5mg

81
Q

what does IM stand for

A

intra muscularly

82
Q

what does SC stand for

A

sub cutaneous

83
Q

when is familial aggregation shown in periodontitis

A

early onset and progresses fast

84
Q

what do genetic factors may increase the susceptibility to other associated chronic conditions

A

Cancer
Heart disease
Diabetes

85
Q

what are other risk factors

A

Osteoporosis
Dietary Calcium
Vitamin D
Obesity

86
Q

what is osteoporosis

A

reduced bone mineral density

87
Q

who is osteoporosis most common in

A

post menopausal women but does occur in men

88
Q

what does osteoporosis lead to

A

an increase risk of fracture

89
Q

what leads to increased bone resorption

A

reduced oestrogen production

90
Q

what is systemic bone resorption associated with

A

MANDIBULAR BONE RESOPTION

91
Q

what should patients with diabetes mellitus be told

A

At increased risk of periodontitis
Glycaemic control may be more difficult
At higher risk of other complications eg cardiovascular disease
And should:
Receive thorough oral/perio exam (adults and children)

92
Q

if the patient doesn’t have periodontitis and no DM what should we do

A

Prevention, monitor

If risk for Type 2 DM, inform patient, do chairside HbA1c or refer to GP

93
Q

if the patient has periodontitis and diabetes what do we do

A

and three stages of therapy Manage acute infections, oral complications; dental rehabilitation if tooth loss

CSA (51 decks)

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