diabetes mellitus

Question 1

If someone has low blood sugar, how is normal blood glucose achieved?

Answer 1

Pancreatic alpha cells synthesise and secrete glucagon

This stimulates the liver to break down glycogen and release glucose into the blood

Question 2

If someone has high blood sugar, how is normal blood glucose achieved?

Answer 2

Pancreatic beta cells synthesise and secrete insulin

This stimulates muscles and fat cells to take glucose from the blood

Question 3

What is diabetes mellitus?

Answer 3

Metabolic disorder of carb metabolism characterised by hyperglycaemia
High morbidity and mortality

Question 4

What are blood glucose levels like?

Answer 4

FASTING-
Normal- 3-5mmol/l
Diabetic- 4-7mmol/l

AFTER A MEAL-
Normal- <10mmol/l, 90 mins post food
Diabetic- >20mmol/l =hyperglycaemia

Question 5

What are symptoms of diabetes?

Answer 5

Blurry vision 
Excessive thirst and urination
Tiredness, feeling unwell
Recurring skin, gum, bladder problems
Dry, itchy skin
Unexpected weight loss
Slow healing cuts/bruises
Loss of feeling or tingly feet

Question 6

What are complications of diabetes?

Answer 6

MACROVASCULAR
-stroke, heart disease (clotting, inflammation etc), peripheral vascular disease

MICROVASCULAR
-retinopathy (macular edema, haemorrhage etc), nephropathy (damaged glomeruli, hyperfiltration etc), peripheral neuropathy (nerve damage, necrosis etc), foot problems

Question 7

What are the types of diabetes mellitus?

Answer 7

Type I (insulin dependent)
Type II
Gestational diabetes
Pre-diabetes- impaired glucose tolerance and impaired fasting glycaemia

Question 8

What is type I diabetes?

Answer 8

Chronic disease, generally childhood
Can be associated w thyroid disease
Genetic susceptibility 
Linked to viral infection (eg congenital rubella syndrome)
Lack of insulin production
Thought to be autoimmune mediated disorder
Affects islets of Langerhans
Beta cells killed by antibodies

Question 9

What is Type II diabetes?

Answer 9

Genetic predisposition
~defect in primary beta cells
~poor insulin secretion
Environmental
~obesity
~periphery insulin resistance

Question 10

What are the symptoms of Type II diabetes?

Answer 10

1. Polyuria (osmotic diuresis—> frequent urination)
2. Polydisia (polyuria—> more thirst and fluid intake)
3. Polyphagia (increased appetite)
   Also dry mouth, itchiness, more thrush, cramps, skin infections

Question 11

What is gestational diabetes?

Answer 11

Occurs 2-5% of all pregnancies
Onset in late 2nd trimester
Predisposition- age- (usually >35), obesity, ethnicity
No obvious symptoms but can show classic diabetes symptoms
Hormonal changes—> cells less responsive to insulin
So increased resistance to insulin and high blood sugar
Long term- larger babies, mum at risk of Type II

Question 12

What is pre-diabetes?

Answer 12

Precursor associated w obesity
High fasting blood glucose but not enough symptoms to diagnose
Lifestyle changes can reduce (50%) risk of diabetes
IFG and IGT

Question 13

What is impaired glucose tolerance?

Answer 13

High blood sugar after eating
25-75% progress to diabetes in 10 yrs
Increased risk of cardiovascular problems

Question 14

How is glucose tested?

Answer 14

Fasting plasma glucose
~not eaten for 8hr (detects D and preD)
Oral glucose tolerance test
~not eaten for 8hr and 2hr after glucose drink (detects D and preD)
Random plasma glucose test
~irrespective of eaten or not (D only)
Over a period of weeks-months-
~glycated haemoglobin A1c
~fructosamine

Question 15

What is glycated haemoglobin A1c?

Answer 15

Measures glucose associated w haemoglobin
RBC- life span is up to 3mnths
Hb1Ac indicates average glucose lvl during this period
Normal- 3.5-5.5%
Diabetic- ~6.5%
Can’t do if sickle cell anaemia, blood loss, haemolytic anaemia
Over-the-counter tests

Question 16

What is the fructosamine test?

Answer 16

Measures glucose associated w protein
Glycated serum protein eg. Glycated albumin
Lifespan- 2-3 weeks

Question 17

How can diabetes be managed?

Answer 17

Lower blood glucose levels

Type I
~essential- insulin
~exercise
~diet

Type II
~weight reduction
~diet
~exercise 
~if not, hypoglycaemic meds and insulin

Question 18

What are some dietary changes?

Answer 18

Avoid adding sugar
Avoid foods sweetened w sugar/honey
Increase carbs before sustained exercise
Limit saturated and hydrogenated fats and cholesterol
Monitor blood sugar regularly
Regular meal times
Important to follow up care

Question 19

What are some treatments where other changes can’t be implemented?

Answer 19

Biguanides- metformin
~inhibits gluconeogenesis in liver
~useful in obese patients
However,
~GI disturbance and even lactic acidosis

Sulphonylureas- tolbutamide, gliclazide, glimepiride
~increase insulin production (required functioning islets of Langerhans)
~long lasting (however- hypoglycaemia in elderly or w kidney problems)
However,
~stimulates appetite (weight gain), hypoglycaemia, GI upsets, potentially teratogenic

Question 20

What are the links between diabetes and oral health?

Answer 20

Gum diseases- red, swollen gums, increased bleeding when brushing, increased plaque
Tooth decay, inflamed and sore tissues, ulcers, gingivitis and then periodontitis
Xerostomia (less saliva flow, less antimicrobial effect, more oral infections)
Bacteria can enter blood stream- endocarditis
Cholesterol build up in blood stream- atherosclerosis
Changes in healing times
Bigger risk w smoking and age