Week 10 - Diabetes Flashcards
define diabetes
a disorder of the metabolism causing excessive thirst and the production of large amounts of urine
diabetes mellitus vs diabetes insipidus?
insipidus: diabetes caused by a deficiency of vasopressin (hormone which regulates kidney function)
mellitus: characterized by hyperglycaemia resulting from defects in insulin secretion or insulin function (or both)
difference between type 1 and type 2 diabetes?
type 1 is due to the shortage of insulin, type 2 is due to resistance of insulin or insufficient insulin
name 5 types of diabetes?
- type 1
- type 2
- MODY (maturity onset diabetes of the young)
- gestational diabetes
- diabetes due to other causes
what are the “other causes” of diabetes?
pancreatic pathology: pancreatic cancer/cyst, drugs or endocrine disease
type 1 diabetes - what is the method for tx?
- insulin injections
type 2 diabetes - what is the core defect in this disease? what is it caused by?
- insulin resistance, and B-cell dysfunction
- caused by genetic susceptibility, obesity and adopting a western lifestyle
explain the concept of insulin resistance and how it causes diabetes?
in normal insulin: insulin binds to receptor, triggering production of glucose transport proteins to allow glucose to enter the cell.
in insulin resistance: receptor is not as responsive, therefore less glucose can enter the cell. this leaves a buildup of glucose in the blood -> diabetes
what causes insulin resistance? these factors lead to?
- ectopic fat accumulation and increased free fatty acid (FFA) circulation
- increased inflammatory mediators
these lead to inhibition of insulin via serine kinases responsible for phosphorylation of insulin receptor substrate, resulting in: - reduction in insulin-stimulated glycogen synthesis due to reduced glucose transport
type 2 diabetes: what happens to blood glucose levels as beta-cell function declines?
- it increases.
- insulin resistance increases as well
type 2 diabetes: treatment?
treated in a stepwise manner, to attempt to control hyperglycaemia
- diet & exercise
- oral monotherapy
- oral combination
- injectable & oral therapy
type 2 diabetes tx: examples of lifestyle changes to be made?
- weight loss
- exercise
- smoking cessation
- improve diet
drug treatment for diabetes: what should be considered?
- duration of diabetes
- weight/lifestyle
- degree of improvement required
- mode of delivery
- adverse effects
- patient preference
- cost
monitoring blood glucose: methods of monitoring?
- HbA1C - average blood glucose over 6-8 weeks. target in diabetes is 6.5-7.5%/48-58mmol/mol. normal range 4-6%
- home blood glucose monitoring (HBGM): target level b4 meals: 4-7, after meals <10
- ketones
general aims of therapy in diabetes?
- prevent hyperglycaemia
- avoid hypoglycaemia
- reduce chronic complications: micro/macrovascular disease
chronic complications in diabetes:
macrovascular?
microvascular?
others?
- macrovascuar: IHD, stroke
- microvascular: neuropathy, nephropathy, retinopathy
- erectile dysfunction
- psychiatric
diabetes is the leading cause of?
- blindness
- dialysis
- amputation
procedures used to screen for microvascular complications?
- annual urinary albumin creatinine ratio (ACR): screen for diabetic kidney disease
- annual retinal photograph
- annual foot screening
alternative definition of diabetes?
- a state of premature cardiovascular death which is associated with chronic hyperglycaemia, and may also be associated with blindness and renal failure
CVR reduction guidelines:
cholesterol?
BP?
aspirin?
- lipid lowering therapy in diabetes over age 40, regardless of baseline cholesterol
- <130/80, as low as possible if microalbuminuria
- not recommended for primary prevention but may be used for secondary prevention and if CVR>10% in 10 years
what happens when glucose falls?
- what is released? why?
- side effects?
- symptoms can be divided into?
- release of counter regulatory hormones: glucagon, adrenaline, cortisol. aim is to stimulate glycogenolysis
- side effects: palpitations, sweats, flushing
- autonomic: sweats, shakes, flushing, palpitations
- neuroglycopenic: confusion, reduced GCS, collapse, seizures, coma
how do the symptoms of hypoglycaemia change from repeated exposure?
- repeated exposure leads to the gradual reduction in warning signs
- progressive loss of counter regulatory hormone
precipitating factors for hypoglycaemia? x9
- dosage of oral hypoglycaemic agents (OHG) or insulin
- errors in dosage administered
- timing of medication esp. insulin
- delay in meals
- alcohol
- exercise
- co-morbidity such as renal insufficiency
- adrenal insufficiency
- pituitary insufficiency
acute complications of hyperglycaemia for type 1/2 diabetes?
- diabetic ketoacidosis (DKA): type 1 diabetes
- hyperosmolar non-ketoic coma: type 2 diabetes
precipitating factors of diabetic ketoacidosis?
- acute illness
- comorbidity
- injury or infection
- medications
- poor compliance or errors in compliance with treatment
- psychological/social issues
diabetic ketoacidosis: what to measure in order to detect?
- ketones
- acidosis
need admission: IV fluids, IV insulin
diabetes: brings on risk of what other conditions?
- stroke
- visual impairment
- renal disease
- CV disease
how will diabetes affect oral health or dental disease?
- higher risk of periodontal disease in diabetes
- high glucose = poor healing/increased infection
- small blood vessel change = reduced blood flow
- worse if patient has poor OH, smokes.
- also worsened by viral infections and concomitant medications (antihypersensitives)
