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CMS > Week 10 - Diabetes > Flashcards

Week 10 - Diabetes Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

define diabetes

A

a disorder of the metabolism causing excessive thirst and the production of large amounts of urine

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2
Q

diabetes mellitus vs diabetes insipidus?

A

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)

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3
Q

difference between type 1 and type 2 diabetes?

A

type 1 is due to the shortage of insulin, type 2 is due to resistance of insulin or insufficient insulin

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4
Q

name 5 types of diabetes?

A
  • type 1
  • type 2
  • MODY (maturity onset diabetes of the young)
  • gestational diabetes
  • diabetes due to other causes
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5
Q

what are the “other causes” of diabetes?

A

pancreatic pathology: pancreatic cancer/cyst, drugs or endocrine disease

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6
Q

type 1 diabetes - what is the method for tx?

A
  • insulin injections
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7
Q

type 2 diabetes - what is the core defect in this disease? what is it caused by?

A
  • insulin resistance, and B-cell dysfunction

- caused by genetic susceptibility, obesity and adopting a western lifestyle

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8
Q

explain the concept of insulin resistance and how it causes diabetes?

A

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

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9
Q

what causes insulin resistance? these factors lead to?

A
  • 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
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10
Q

type 2 diabetes: what happens to blood glucose levels as beta-cell function declines?

A
  • it increases.

- insulin resistance increases as well

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11
Q

type 2 diabetes: treatment?

A

treated in a stepwise manner, to attempt to control hyperglycaemia

  1. diet & exercise
  2. oral monotherapy
  3. oral combination
  4. injectable & oral therapy
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12
Q

type 2 diabetes tx: examples of lifestyle changes to be made?

A
  • weight loss
  • exercise
  • smoking cessation
  • improve diet
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13
Q

drug treatment for diabetes: what should be considered?

A
  • duration of diabetes
  • weight/lifestyle
  • degree of improvement required
  • mode of delivery
  • adverse effects
  • patient preference
  • cost
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14
Q

monitoring blood glucose: methods of monitoring?

A
  • 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
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15
Q

general aims of therapy in diabetes?

A
  1. prevent hyperglycaemia
  2. avoid hypoglycaemia
  3. reduce chronic complications: micro/macrovascular disease
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16
Q

chronic complications in diabetes:
macrovascular?
microvascular?
others?

A
  • macrovascuar: IHD, stroke
  • microvascular: neuropathy, nephropathy, retinopathy
  • erectile dysfunction
  • psychiatric
17
Q

diabetes is the leading cause of?

A
  • blindness
  • dialysis
  • amputation
18
Q

procedures used to screen for microvascular complications?

A
  • annual urinary albumin creatinine ratio (ACR): screen for diabetic kidney disease
  • annual retinal photograph
  • annual foot screening
19
Q

alternative definition of diabetes?

A
  • a state of premature cardiovascular death which is associated with chronic hyperglycaemia, and may also be associated with blindness and renal failure
20
Q

CVR reduction guidelines:
cholesterol?
BP?
aspirin?

A
  • 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
21
Q

what happens when glucose falls?

  • what is released? why?
  • side effects?
  • symptoms can be divided into?
A
  • 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
22
Q

how do the symptoms of hypoglycaemia change from repeated exposure?

A
  • repeated exposure leads to the gradual reduction in warning signs
  • progressive loss of counter regulatory hormone
23
Q

precipitating factors for hypoglycaemia? x9

A
  • 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
24
Q

acute complications of hyperglycaemia for type 1/2 diabetes?

A
  • diabetic ketoacidosis (DKA): type 1 diabetes

- hyperosmolar non-ketoic coma: type 2 diabetes

25
Q

precipitating factors of diabetic ketoacidosis?

A
  • acute illness
  • comorbidity
  • injury or infection
  • medications
  • poor compliance or errors in compliance with treatment
  • psychological/social issues
26
Q

diabetic ketoacidosis: what to measure in order to detect?

A
  • ketones
  • acidosis

need admission: IV fluids, IV insulin

27
Q

diabetes: brings on risk of what other conditions?

A
  • stroke
  • visual impairment
  • renal disease
  • CV disease
28
Q

how will diabetes affect oral health or dental disease?

A
  • 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)

CMS (16 decks)

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