diabetes

Question 1

diabetes mellitus vs diabetes insipidus

Answer 1

diabetes means pee alot

mellitus = glucose in pee (glucose regulation problem)

insipidus = no glucose in pee (renal function problem, lack of adh)

Question 2

type 1 or type 2 diabetes mellitus more common

Answer 2

type 2 85%

Question 3

type 1 vs type 2

Answer 3

o type 1 -> no insulin production

o type 2 -> poor response to insulin

Question 4

what other medical conditions are diabetes related to?

Answer 4

infection
poor wound healing
stroke
MI
peripheral neuropathy and artery disease
retinopathy
diabetic foot
cataract
renal disease

Question 5

how to test for diabetes?

Answer 5

high plasma glucose >11.1mmol/L

Glucose tolerance test

HbA1C >48mmol/molo (glycosylated haemoglobin)

Question 6

what is glucose tolerance test?

Answer 6

given 75g of glucose and sugar level accessed after 2 hours

results can be normal, impaired fasting glucose or diabetes

Question 7

if you are found to have impaired fasting glucose from a GTT test, what does it mean?

Answer 7

pre diabetic

Question 8

what is glycosylated haemoglobin HbA1C??

Answer 8

used to MONITOR diabtes, tells you if sugar control has been good or bad for the past few weeks

o measure of how much glucose residue is stuck to the surface of Hb

o glucose residue increases with time, signifies increasing sugar concentration in blood

Question 9

Ketoacidosis

Answer 9

body cannot access glucose for metabolism and energy so starts to metabolise fat which results in ketones and acid

Question 10

what is GAD ICA IAA

Answer 10

• GAD = glutamic acid decarboxylase
• ICA = islet cell antibodies
• IAA = insulin auto antibodies

Question 11

What does insulin resistance mean?

Answer 11

blood glucose constantly high so insulin becomes less sensitive, requires larger amounts of insulin to lower blood glucose levels

high basal insulin levels
B cell response to hyperglycaemia is inadequate
failure of gluconeogenesis suprresion
glucose movement is poorly repsonsive so glucose uptake is reduced

Question 12

insulin resistance found in which type of diabetes

Answer 12

2

Question 13

Diabetes related to medications

Answer 13

• corticosteroids (insulin antagonists)
• immune suppressants
• cancer meds
• antipsychotic meds
• antiviral

Question 14

Diabetes related to which endocrine diseases

Answer 14

• Cushings (excess cortisol)
• Phaeochromocytoma (adrenaline tumour)
• Acromegaly (excess growth hormone)

Why? Because a change in hormone levels will change the ability of the body to handle glucose load

Question 15

what is gestational diabetes

Answer 15

pregnant women, increased metabolism but once baby born back to normal

Question 16

type 1 causes

Answer 16

autoimmune destruction of B cells (Lymphocytes attack pancreatic islets of Langerhans )
genetic + environment

Question 17

is type 1 and 2 rapid/ chronic progression

Answer 17

type 1 - rapid
type 2 - chronic

Question 18

in which type will there be ketoacidosis?

Answer 18

acute presentation
EMERGENCY
in type 1

rare in type 2

Question 19

increase in GAD ICA and IAA indicates what?

Answer 19

Circulating antibodies indicates loss of pancreatic function : type 1 diabetes

Question 20

is type 1 and type 2 more common in kids or adults

Answer 20

type 1 - kids but adults possible (LADA)

type 2 - adults but kids sometimes (MODY)

lada latent autoimmune diabetes in adult
mody mature onset diabetes in young

Question 21

• polyuria (pee)
• polydipsia (thirst)
• tiredness

Answer 21

symptoms of type 1

Question 22

symptoms of type 2

Answer 22

• impaired glucose tolerance
• hypertension
• obesity
• early and accelerated atherosclerosis
• retinal damage
• infections like oral candidiasis
• MI/stroke

Question 23

insulin injections in which type

Answer 23

1 but 2 also can

Question 24

how to manage diabetes?

Answer 24

education on diet and lifestyle more exercise less carbs

blood glucose targets

reduce risks from associated dieases using drugs

insulin injections

Question 25

how is insulin injected

Answer 25

subcutaenously either split mix or basal bolus

Question 26

split mix vs basal bolus for insulin injections

Answer 26

1. split mixed = less injections less controlled 2. basal bolus = more injections more controlled

Question 27

why do we give diabetes patients CVS drugs

Answer 27

high blood sugar levels for a period of time, your blood vessels can start to get damaged, glucose sticks to your red blood cells and builds up in your blood. leading to eye, feet problems etc o antiplatelet o stains o antihypertensives

Question 28

why must exercise be planned for type 1 diabetic patients?

Answer 28

might risk hypoglycaemia

Question 29

ideal HbA1C levels

Answer 29

6-10% o if too high -> retinopathy o if too low -> hypoglycaemia *glycosylated haem used to monitor sugar control over time

Question 30

why is retinopathy a complication of diabetes?

Answer 30

small blood vessels in the eye get swollen

Question 31

type 1 diabetes monitoring machine name

Answer 31

closed loop glucose monitoring continuous glucose monitoring

Question 32

type 2 diabetes tx

Answer 32

- avoid CHO and fat diet - bariatric surgery - medications

Question 33

first line drug for t2 diabetes

Answer 33

metformin enhances cell insulin sensitivity reduces hepatic gluconeogenesis

Question 34

what are gliptins

Answer 34

DDP-4 inhibitors (Gliptins) drug for t2 diabetes - blocks metabolism of incretin - incretin stays in circulation for longer

Question 35

what is incretin

Answer 35

stimulates a decrease in blood glucose levels, stimulates insulin release

Question 36

Sulphonylureas

Answer 36

drug for type 2 - increases pancreas insulin secretion - but can cause hypoglycaemia

Question 37

Complications of diabetes treatment

Answer 37

in type 1, inject insulin but dont consume food -> acute hypogly in typw 2, take med sulphonylurea -> too much insulin secreted can cause acute hypogly

Question 38

when to prescribe additional insulin

Answer 38

Type 1 requires more insulin during surgery Type 2 requires insulin after operation for wound healing and prevent infection

Question 39

why is fasting before surgery a problem for type 1 diabetes

Answer 39

o might lead to acute severe hypoglycaemia since insulin taken but cannot eat food o need insulin to prevent ketosis o usually admitted to hospital for glucose drip

Question 40

what metabolic changes associated with surgery

Answer 40

o higher demand for energy o adrenaline o cortisol o hormone changes aggravate diabetes o more glucose formed less muscle uptake o metabolic acidosis likely

Question 41

in dentistry what do you have to look out for in diabetic patients

Answer 41

food intake after procedure may be disrupted, patient may not want to eat after a procedure but they MUST otherwise hypogly acute emergencies ketoacidosis or acute hypogly infection risk poor wound healing