systemic risk factors part 2 Flashcards by Yusra Khan

what is the definition of diabetes

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

How well did you know this?

Not at all

Perfectly

what is diabetes characterised by

chronic hyperglycaemia

How well did you know this?

Not at all

Perfectly

what does chronic hyperglycaemia result from

insulin deficiency or impaired utilisation of insulin

How well did you know this?

Not at all

Perfectly

what is the full name of diabetes

diabetes mellitus

How well did you know this?

Not at all

Perfectly

what can the medication of diabetes result in

hypOglycaemia

How well did you know this?

Not at all

Perfectly

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

451 million ( aged 18-99 years)

How well did you know this?

Not at all

Perfectly

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

693 million

How well did you know this?

Not at all

Perfectly

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

3.7 million

How well did you know this?

Not at all

Perfectly

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

12.3 million

How well did you know this?

Not at all

Perfectly

what percentage of people have type 1 diabetes in the uk

10%

How well did you know this?

Not at all

Perfectly

what percentage of people have type 2 diabetes in the uk

90%

How well did you know this?

Not at all

Perfectly

what is the % of gestational diabetes

3.5%

How well did you know this?

Not at all

Perfectly

what type of diabetes can we get in young adults

1-2%

MATURITY ONSET DIABETES

How well did you know this?

Not at all

Perfectly

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

1 million

How well did you know this?

Not at all

Perfectly

describe type 1 diabetes

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

How well did you know this?

Not at all

Perfectly

describe type 2 diabetes

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

How well did you know this?

Not at all

Perfectly

what is the typical age group for type 1 diabetes

abrupt onset, most often in children or teens

How well did you know this?

Not at all

Perfectly

what is the typical age group for type 2 diabetes

mid life but now can be seen in younger ages

How well did you know this?

Not at all

Perfectly

what are the risk factors for type 2 diabetes

Sedentary lifestyle, obese, asian/afro carribean

How well did you know this?

Not at all

Perfectly

how can we test for diabetes

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

How well did you know this?

Not at all

Perfectly

what does the random venous plasma glucose levels have to be

greater than or equal to 11.1 mmol per litre

How well did you know this?

Not at all

Perfectly

what does the fasted venous plasma glucose levels have to be

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

How well did you know this?

Not at all

Perfectly

what is polyuria

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)

How well did you know this?

Not at all

Perfectly

what is polydipsia

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.

How well did you know this?

Not at all

Perfectly

what should normal blood glucose levels be

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

How do we use HbA1c To test for diabetes

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

what is the cut off point for HbA1C

48 mmol per mol (6.5%)

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

6.5-7.5% | AKA 48-58mmol/mol

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

4-6% | 20-42 mmol/mol

what are the implications of poorly controlled diabetes

diabetes complication | risk factor for perio diseases

how can we treat type 1 diabetes

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

how do we treat type 2 diabetes

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

how do we carry out a home glucose monitor

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

what do we aim for on a home glucose strip

4-7 mmol per litre | under the renal threshold of 10 mmol per litre

what is the new technology for home glucose monitoring

flash glucose sensor

what are the complications of diabetes

macrovascular | microvascular

what are the macrovascular complications of diabetes

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

what are the microvascular complications of diabetes

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

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

30.2%

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

66.8%

what is the target percentage for diabetics

less than 7.5%

what does diabetics cost the nHS

23.7 BILLION in uk

how much do diabetic patients take of the NHS budget

10%

what percentage of hospital beds to diabetics take up

19%

what level will people start expiring hyocylcaemic effects

under 4mmol per litre

what is the projected cost for diabetes in 2035/2036

39.8 billion

what do studies show

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

what is there an increase risk of in the study

of perio disease with age | increased severity with the duration of diabetes

what do Pima indians have a higher prevalence of

type 2 diabetes

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

2.8 x

what is the increased risk of bone loss n pima indians

3.4 x

what is the risk of mortality in pima indians

3.2 x | due to ischaemic heart disease and nephropathy

what is the central feature of pathogenesis of DM and periodontitis

inflammation

what can cause systemic inflammatory response

perio infections

what is there an increase of in systemic inflammation

acute phase proteins such as C reactive protein | and pro inflammatory cytokines

give an example of acute phase protein

C reactive protein

what is stimulated in obesity

IL-6 stimulates TNF-alpha

what molecule stimulatied TNF- alpha

IL-6

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

insulin resistance- in type 2 diabetes

what might an increase in IL-B cause

pancreatic ß cell destruction- in type 1 diabetes

what is AGE

advanced glycation end products

how do we get AGE

from hyperglycaemia which leads to collagen undergoing non enzymatic glycation

what changes occur which leads to AGE forms

increased crosslinking- negative cross links | increased cytokine production

what occurs after increased cytokine production

microvascular complications atherosclerosis decreased production of bone matrix

what is RAGE

RECEPTOR FOR AGES

What activates the RAGES

ages

what happens when RAGES and AGES interact

Microvascular & macrovascular diabetes complications | Accelerated periodontal tissue destruction

what is linked to LOA

BMI which is related to obesity

what happens to PMN in diabetes mellitus

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

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

periodontal diseases adversely affect diabetes outcomes:

with less HbA1C there is a reduced risk of

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

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

21%

what is the reduced % of myocardial infarction when less Hb1AC

14%

what is the reduced % of microvascular complications when less Hb1AC

37%

what do we advise for perio care in diabetics

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

how do we manage hypoglycaemia

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

what are the clinical symptoms of hypoglycaemia

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

how do we manage severe hypoglycaemia

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

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

1mg

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

0.5mg

what does IM stand for

intra muscularly

what does SC stand for

sub cutaneous

when is familial aggregation shown in periodontitis

early onset and progresses fast

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

Cancer Heart disease Diabetes

what are other risk factors

Osteoporosis Dietary Calcium Vitamin D Obesity

what is osteoporosis

reduced bone mineral density

who is osteoporosis most common in

post menopausal women but does occur in men

what does osteoporosis lead to

an increase risk of fracture

what leads to increased bone resorption

reduced oestrogen production

what is systemic bone resorption associated with

MANDIBULAR BONE RESOPTION

what should patients with diabetes mellitus be told

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)

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

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

if the patient has periodontitis and diabetes what do we do

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