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Diabetes Flashcards

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1
Q

Look at diagrams on slides

A

Look at diagrams on slides

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2
Q

Uses of blood glucose

A

Muscle storage for later use (glycogen)
Energy source for muscle and other tissues
Storage as fat (triglycerides)
Liver storage for later use (glycogen)
Energy for CNS and brain (60-70%)
Excretion in urine with high blood sugar (~>160mg/dL)

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3
Q

Regulation of blood glucose

A

Maintenance of blood glucose levels essential
Too high: release of water from tissues due to osmotic pressure: dehydration, death
Too low: lack of fuel to produce ATP
-brain depends on glucose as fuel (can’t use fats etc.) –> coma
-RBCs low on ATP; can’t provide oxygen to tissues –> death

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4
Q

Low blood sugar –>

A

alpha cells in pancreas respond

  • release glucagon
  • stimulates liver to break down glycogen and release glucose into blood
  • normal blood glucose achieved
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5
Q

High blood sugar –>

A

Beta cells in pancreas respond

  • release insulin
  • stimulates muscles and fat cells to take glucose from blood
  • normal blood glucose achieved
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6
Q

Diabetes origin

A

From latin - siphon
From Greek - a passing through (reference to excessive urination)
Recognised for 2000 years
Originally diagnosed by sweet taste of urine
Known as Pissing Evil in 17th century

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7
Q

Blood glucose levels fasting

A

Normal fasting conditions: 3-5 mmol/l

Diabetic fasting conditions: 4-7 mmol/l

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8
Q

Blood glucose after a meal

A

Normal: less than 10 mmol/l 90 min post food
Diabetes: >20 mmol/l

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9
Q

Diabetes mellitus

A

Metabolic disorder of carbohydrate metabolism
Characteristic: hyperglycaemia (> blood glucose)
High morbidity and mortality

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10
Q

Macrovascular complications

A 
Stroke
Heart disease
-atherosclerosis
-endothelial dysfunction
-hypertension
-procoagulant state
-antifibrinolitic state
-vascular inflammation
Peripheral vascular disease
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11
Q

Microvascular complications

A 
Retinopathy
-macular edema
-capillary nonperfusion
-angiogenesis
-haemorrhage
-glaucoma
Nephropathy
-damaged glomeruli
-hyperfiltration
-renal damage
Peripheral neuropathy
-nerve damage
-ulceration
-necrosis
Foot problems
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12
Q

Symptoms of diabetes

A 
Blurry vision
> thirst and need to urinate
Feeling tired or ill
Recurring skin, gum, bladder infections
Dry, itchy skin
Unexpected weight loss
Slow healing cuts and bruises
Loss of feeling or tingling feeling in feet
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13
Q

Types of diabetes

A

Type I (insulin dependent)
Type II
Gestational diabetes
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)

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14
Q

Type I diabetes

A

Chronic (generally) childhood disease
Affects 18-20 per 100,000 children in UK
Sometimes associated with thyroid disease
Genetic susceptibility shown
Linked to viral infection (e.g. congenital rubella syndrome)

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15
Q

Type I diabetes science behind

A 
Lack of insulin production
Thought to be autoimmune mediated disorder
-affects islets of Langerhans
-beta cells killed by antibodies
Therefore, lack of insulin production
Most cases <40
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16
Q

Type 2 diabetes

A

Non-insulin dependent/ adult-onset diabetes

Genetic disposition + environment

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17
Q

Type 2 diabetes causes

A

Genetic disposition:
-multiple genetic susceptibility –> primary beta-cells defect –> damaged/ inadequate insulin secretion
-multiple genetic susceptibility –> periphery insulin resistance –> inadequate uptake
Environment: obesity
—–> hyperglycaemia + free fatty acids –> type 2 diabetes

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18
Q

Insulin resistance

A

Lack of insulin results in low glucose in cells i.e. cells do not take up glucose

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19
Q

Insulin resistance –>

A
  • ->liver: produces glucose from stored glycogen –> slow to replenish glycogen –> glucose not taken by cells and blood glucose increases
  • ->skeletal muscle: < glycogen storage and use of glucose –> glucose not taken by cells and blood glucose increases
  • -> fatty tissue: fat broken down and use as energy source –> > fatty acids as some insulin in present, normal fatty acid metabolism occurs and no ketones are produced
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20
Q

Type 2 diabetes main symptoms

A
  1. Polyuria: frequent urination due to osmotic diuresis
  2. Polydisia: > thirst and > fluid intake due to polyuria
  3. Polyphagia: > appetite
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21
Q

Type 2 diabetes other symptoms

A

Dry mouth, itchiness, > incidence of thrush, cramps, skin infections

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22
Q

Gestational diabetes

A

2-5% of all pregnancies

Onset in late 2nd trimester (20-28 weeks)

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23
Q

Gestational diabetes predisposing factors

Study These Flashcards
A

Age (>35 although can occur in younger mums)
Ethnic group
-6x more common in South Asian descent
-3x more common in African-Caribbean people
Obesity

24
Q

Gestational diabetes symptoms

Study These Flashcards
A 
No obvious external symptoms
On occasions, classic diabetes symptoms are observed
-excessive thirst
-frequent urination
-increased appetite
25
Gestational diabetes causes
Hormonal changes --> cells less responsive to insulin Increased resistance to insulin > blood glucose Long-term effect: larger babies, mum at risk of type 2 diabetes
26
Glucose testing
``` Fasting plasma glucose (FPG) Oral glucose tolerance test (OGTT) Random plasma glucose test Glycated haemoglobin A1c (HbA1C) Fructosamine test ```
27
Fasting plasma glucose (FPG)
Measures blood glucose when person has not eaten for at least 8h (detect diabetes and pre-diabetes)
28
Oral glucose tolerance test (OGTT)
Measures glucose after individual has fasted for at least 8h and 2h after consuming glucose containing drink (detect diabetes and pre-diabetes)
29
Random plasma glucose test
Casual plasma glucose test i.e. measures glucose irrespective of whether person has eaten or not (diagnose diabetic only)
30
Glycated Haemoglobin A1c (HbA1C)
Red cells life spain is ~8-12 weeks Hb1Ac given indication of average glucose level for 8-12 weeks Normal: 2.5-5.5% Diabetes: ~6.5% One of best ways to check that diabetes is under control
31
Fructosamine (Glycated serum protein, glycated albumin) test
``` Formed from serum proteins such as albumin -reaction between fructose and amine Used in cases of -blood loss -haemolytic anaemia -sickle cell anaemia Gives average results for last 2-3 weeks Tends to be basis of over-the-counter tests ```
32
Hyperglycaemia: other factors
Steroids Antipsychotic Diuretics Antihypertensive
33
Hypoglycaemia: other factors
Alcohol Hormone deficiencies Prolonged starvation
34
Management of diabetes aim
To lower blood glucose levels Monitor blood glucose regularly Regular meal times Important to follow up care
35
Management of diabetes type 1
Insulin (essential) Exercise Diet (low in fat, cholesterol and simple sugar)
36
Management of diabetes type 2
Weight reduction Diet Exercise If above not successful then oral hypoglycaemic medications and then insulin
37
Management of diabetes: sugar
Avoid adding sugar to food | Avoid foods sweetened with sugar or honey
38
Management of diabetes: cholesterol and fat
> carbohydrates before sustained exercise | Limit intake of saturated and hydrogenated fats and cholestertol
39
Diabetes treatments
Oral hypoglycaemic agents: - Biguanides (Metformin) - type 2 diabetes and type 1 with insulin therapy - Sulphonylureas (Tolbutamide, gliclazide, glimepiride)
40
Biguanides (Metformin)
Inhibits glucose production by liver (gluconeogenesis) | Useful in pxs who are obese
41
Sulphonylureas
> amount of insulin made in pancreas (required functional islets of Langerhans) Long lasting effect -problem: hypoglycaemia in elderly pxs or those with kidney problems
42
Unwanted effects of Sulphonylureas
``` Appetite stimulants (weight gain) Hypoglycaemia GI upsets (3% of pxs) Potentially teratogenic (do not use in pregnancy or planning one) ```
43
Unwanted effects of Biguanides (Metformin)
- GI disturbance | - lactic acidosis (contrindicated for those with renal, severe pulmonary or cardiac conditions)
44
Drugs that augment hypoglycaemic effects of sulfonylureas
NSAIDs Alcohol Antibacterial (Sulphonamides, trimethoprim, chloramphenicol) Antifungal (Miconazole, fluconazole)
45
Drugs that decrease the actions of sulfonylureas
Diuretics | Corticosteroids
46
Diabetes and oral health
Oral disease has been referred to as 6th 'opathy' of diabetes Dental diseases due to diabetes: gum diseases very common -red and swollen gums -> bleeding while brushing -> plaque Results in periodontitis and gingivitis -gum disease followed by tooth decay -inflamed and sore tissues, ulcers Lack of saliva (xerostomia) Dental hygiene, diabetes and heart problems > bleeding time --> longer to heal
47
Lack of saliva (xerostomia)
< salivary flow --> bacteria and other residues not washed < antimicrobial effect of saliva > oral infections (e.g. thrush very common in diabetics)
48
Dental hygiene, diabetes and heart problems
Bacteria can enter blood stream - endocardititis | Cholesterol build up in blood stream - atherosclerosis
49
Diabetes and smoking
Diabetic smokers have higher risk of dental problems e.g. periodontitis Smoking impairs blood flow and affects healing after dental proceduse Risk increases with smokers > 45 > risks of morbidity and premature deaths (macrovascular complication)
50
Care of diabetic dental pxs: major surgery procedures
Diet control Reduce stress Insulin & blood sugar control Antibiotic requirements
51
Care of diabetic dental pxs: invasiev procedures
``` Morning appointments Reduce stress Current medications; insulin & blood glucose levels Antibiotic requirements Treatment breaks ```
52
Care of diabetic dental pxs: non-invasive procedures
``` Morning appointments Medications being taken Analgesic requirements Need for treatment breaks e.g. bathroom & snacks Stress importance of regular visits ```
53
Pre-diabetes
Precursor to diabetes Tend to lead to full diabetes developing Frequently associated with poor diet/ obesity/ lifestyle issues Abnormally high blood glucose - perhaps not high enough or without symptoms for full diabetes
54
Pre-diabetes forms
Impaired fasting glycaemia | Impaired glucose tolerance
55
Impaired fasting glycaemia
Elevated high blood glucose, not high enough to be diabetic 50% risk of progressing to diabetes Lifestyle changes can reduce risk of progressing
56
Impaired glucose tolerance
After eating, between normal blood glucose and diabetic blood glucose levels Associated with > risk of cardiovascular problems Diet, lifestyle changes reduce risk of progressing

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