Diabetes and obesity Flashcards
(139 cards)
1
Q
Name the main source of energy for the brain
A
Glucose
2
Q
What can the brain use instead of glucose
A
Ketones
3
Q
How much glucose does the brain use
A
80mg glucose/ minute
4
Q
How much glucose do tissues other than the brain use
A
50mg glucose/ minute at rest
5
Q
Can glucose diffuse accorsi cll membranes
A
no
6
Q
How is glucose transported if it can’t diffuse across cell membranes
A
Transported via the GLUT transported
7
Q
Describe theGLUT transporters
A
They are uniporters
they work by providing facilitated transport across cell membranes
8
Q
Name soem different types of GLUT transporters
A
- glut 3
2. GLUT 4
9
Q
Describe GLUT 3
A
It is NOT insulin dependent
Present in Neuronal cells
10
Q
Describe GLUT 4
A
It is insulin dependent
Present in muscle and fat cells
11
Q
What are ketones synthesised from
A
Fatty acids
12
Q
What is the co transporter for glucose
A
Sodium
13
Q
How are ketones transported
A
They can simply diffuse across the blood brain barrier
14
Q
Describe how blood glucose is maintained after meal
A
- Eating increases blood glucose
2. Insulin stores the glucose as glycogen
15
Q
How Is glycogen broken down at rest between meals
A
Glucagon breaks down glycogen
16
Q
How Is glycogen broken down under stress
A
Cortisol and adrenal are related to mobilise stored glycogen
17
Q
Insulin is the _________ pathway
A
Anabolic
18
Q
Glucagon, cortisol, adrenaline are the _________ pathway
A
Catabolic
19
Q
Name the key organ In charge of maintain blood glucose between meals
A
Liver
20
Q
Describe glycogen
A
It is a polysaccharide of glucose
21
Q
Where is glycogen found
A
- LIVER
2. muscles
22
Q
Can muscle glycogen be mobilised into the blood stream
A
NO it is for muscle use only
23
Q
What is the break down of glucose called
A
Glycolysis
24
Q
What is the building of glucose called
A
Gluconeogenesis
25
Name a common disease affecting glucose maintenance
Diabetes mellitus
26
What is diabetes mellitus
A group of disorders with many caused which are characterised by a persistently raised blood glucose level
27
What is diabetes mellitus a result of
1. A lack of insulin
2. An inability to respond to insulin
(can be both)
28
Name the different types of diabetes
1. Type 1 diabetes mellitus
2. Type 2 diabetes mellitus
3. Gestational diabetes
4. Other
29
Give examples of other types of diabetes mellitus
1. Monogenic diabetes
2. Diabetes secondary to pathological conditional such a as trauma or pancreatic surgery
3. Drug induced
30
What is monogenic diabetes
Single gene defect or associated with genetic condition like Down syndrome or turners
31
Which drugs can lead to drug induced diabetes
long-term corticosteroid treatment
32
What does type 1 diabetes result in
An absolute insulin deficiency due to destriction of the beta islet cells in the pancreas
33
What causes beta islet cell destruction
Usually auto immune so T cells mediated destruction of the beta cells in the islets of Langherhans in the pancreas
34
Where are the beta islets cells found
In the pancreas
35
What type of function does the pancreas have
Both endocrine and exocrine
36
When does type 1 diabetes manifest
Usually at 90% destruction of the beta cells
37
Is diabetes type 1 fatal
Yes if patient doesn't receive replacement insulin
38
What are some of the clinical signs that a patient may have type 1 diabetes
1. Polyuria
2. Polydipsia
3. Weight loss (despite an increase in appetite)
4. Fatigue
39
What is polyuria
Excess urination
40
Why is polyuria dangerous
Glucose in the urine causes osmoticdiuresis as urine osmotic pressure increases so kidneys cant retain the water and the patient becomes fluid depleted
41
What is polydipsia caused by
Fluid depltion
42
What is polydipsia
Extreme thirst
43
Why might a patient with type 1 diabetes lose weight without trying
As insulin isn't present to do the anabolic pathway so the catabolic pathways are used to generate energy and they use fat sources
44
What can type 1 diabetics develop if their diabetes isnt controlled
Diabetic ketoacidosis (DKA)
45
What is Diabetic ketoacidosis (DKA)
Increased production of ketones which are acidic, high levels accumulate so metabolic acidosis leads to a fall in blood pH
46
Is Diabetic ketoacidosis (DKA) serious
YES it is a medical emergency with a 5-10% mortality
47
How do we monitor any type of diabetes
Monitor HbA1c blood test every 3 months to check glycated haemoglobin
48
What is the idea level of HbA1c
Ideally below 48mmol/mol or 6.5%
49
What is Diabetic ketoacidosis (DKA)
It is a complication of type 1 diabetes mellitus
50
Describe the presentation of Diabetic ketoacidosis (DKA)
1. Rapid deterioration
2. Confusion
3. Nausea, vomiting
4. Abdominal pain and shaking
5. Diminshed consciousness in later stages
51
When is Diabetic ketoacidosis (DKA) more likely to happen
1. Infection
2. Missed insulin dose
3. Surgery
4. Binge drinking
52
What should you advise people with type one diabetes if you carry treatment on them
Make sure you tell patients that they still need to take their insulin and check their Especiallyif you have provided an intervention whereby they may not be able to eat or want to eat.
53
What is type 2 diabetes mellitus
It is a complex metabolic characterised by varying degrees to insulin resistance
54
What causes type 2 diabetes mellitus
dysfunction of beta cells in pancreas
55
Does DKA happen to patients with type 2 diabetes
NO they get Hyperosmolar hyperglycemic syndrome (HHS)
56
What is HHS
Hyperosmolar hyperglycemic syndrome (HHS)
57
Describe Hyperosmolar hyperglycemic syndrome (HHS)
A very scary reaction that is difficult to manage and has a high mortality rate
58
How might the beta cells of the pancreas be dysfunctional
They may fail to send intracellular signally pathways that normally operate one insulin has bounce to the surface of a cell
59
Is the net blood glucose levels of a patient with type 2 diabetes higher or lower Ethan normal
Higher
60
What foes dysfunction of the beta cells lead to
Deregulation of normal homeostatic mechanisms to produce insulin appropriately
61
Initially what can happen earn the beta cells start to dysfunction
there may be period of excessive insulin production as more is produced in an attempt to counteract the resistance
The beta cells eventually fail due to lack of insulin production
62
List some risk factors of type 2 diabetes
1. Obesity
2. Family history
3. Ethnicity
4. History of gastrointestinal diabetes
5. Poor diet
6. medications
7. PCOS and other metabolic syndrome
63
What is the Link between type 2 diabetes and obesity
80 times more likely to develop type 2 diabetes if you have a BMI of <23
64
Which ethnicities are more likely to have type 2 diabetes
Asian, African and black communities are 2-4 times more likely to develop type 2 diabetes
65
Describe a poor diet
Low fibre high GI diet
66
What is gestational diabetes
Diabetes first recognised in pregnancies
67
In whom is gestational diabetes more common in
Asian
68
Why are the cases of gestational diabetes increasing
Increasing with obese mothers or pregnancy later in life
69
When does gestational diabetes likely to develop
In the second half of pregnancy
70
What is gestational diabetes associated with
1. Increased size of fortis (Macrosomia)
| 2. Increased risk to mother eg increased risk of c section and miscarriages
71
Is gestational diabetes permanent
Mostly resolved post partum but increases your risk by 7 to develop diabetes later in life
72
What impact does having chronic diabetes have
1. Microvascular disease
2. Macrovascular diseas
3. Metabolic disease
73
Give examples of some microvascular diseases that can occur in chronic diabetes
1, Nephropathy
2. retinopathy
3. neuropathy
74
What can happen in microvascular complication of diabetes
Capilalry endothelial becomes damaged and basement membrane thickens
75
Give examples of some macrovascular diseases that can occur in chronic diabetes
1. CVD,
2. cerebrovascular disease
3. peripheral arterial disease
76
What can happen in macrovascular complication of diabetes
Accelarated atherosclerosis
77
Give examples of some metabolic complations that can occur in chronic diabetes
Dyslipidaemia and 'metabolic syndrome'
78
There is a significant relationshio between diabetes and..?
Wound healing
79
Why is immune healing affected during diabetes
Due to altered immune state whereby neutrophils are abnormal and don’t stick or roll well to the endothelium
80
What effect can diabetes mellitus have on the oral cavity
1. Periodontal
2. Xerostomia
3. Sialosis
4. Fungal infections
5. Adverse taste
81
How does diabetes affect the periodontal status of the oral cavity
1. Altered immune function
2. Salivary gland function altered
3. Increased periodontal destruction
82
When does the risk of periodontal disease increase in diabetic patients
Increases with poor glycemic control
83
How can diabetes cause Xerostomia
Dehydration from hyperglycaemia decreases saliva production and alters the quantity and quality of saliva
84
Why do we think diabetes can change the quality and quantity of saliva
probably due to microvascular and autonomic neuropathy.
85
What is Sialosis
Asymptomatic and non-inflammatory enlargement of major salivary glands
86
Which fungal infections most common in the oral cavity
Candidiasis
87
Why might diabetic patients have an adverse taste in their mouth
usually side-effects of medicines eg Metformin (metallic taste)
88
How can we manage type 1 diabetes
1. Long acting insulin
| 2. Short acting insulin
89
Name the long acting insulin
Lantus
90
Name the short acting insulin
Humalog
91
How can we manage type 2 diabetes
1. Weight management
| 2. Medication
92
Give examples of some oral hypoglycaemic agents
1. - Biguanides
2. Gliptins
3. Sulphonylureas
4. α-glucosidase inhibitors
5. Glitazones -
6. Meglitinides
93
Give an example of Biguanides
Metformin-
94
Give an example of Gliptins
Sitagliptin-
95
Give an example of Sulphonylureas
Gliclazide
96
Give an example of α-glucosidase inhibitors
Acarbose
97
Give an example of Glitazones
Pioglitazone
98
Give an example of Meglitinides
Rapaglinide
99
Describe Biguanides
They only work in the presence of insulin
100
How do Biguanides work
They lower plasma glucose but increasing peripheral itilisation of glucose and decreasing gluconeogenesis
101
How do Gliptins work
Inhibit enzyme DPP-4, which plays a major role in glucose metabolism. Indirectly stimulates more insulin production and reduced glucagon secretion
102
What do Sulphonylureas do
They augment insulin secretion
103
How do Sulphonylureas work
They endive hypoglycaemia if taken but a meal is missed
104
What does alpha glucosidase do
It reduces carb absorption by the gut (this can lead to carb femetntion in the gut and abdominal side effects)
105
What do Glitazones do
They enhance the effects of endogenous insulin
106
What is a side effect of Glitazones
Fluid retention
107
What are Metglitinides
They are glucose regulators with enhance insulin secretion
108
Give example of technology we can use to manage diabetes mellitus
1. Freestyle libre
| 2. Medtronic Insulin pump
109
Describe how a freestyle libre works
It saves repeated CBG measurements
| You how a computer over the sensor for a reading
110
How do insulin pump work
They deliver precise basal rates of insulin via cannula
111
How much insulin can an insulin pump hold
Holds around 300 units of insulin which can last 2-3 days
112
What must you do to the cannula in an insulin pump
Rotate it around to avoid lipodystrophy
113
How does the WHO define obesity
Defined as a BMI over 30
114
How is BMI calculated
Weight(KG)/ heightxheight
115
What is an ideal BMI
18.5-25
116
When is BMI not a good tool to measure obesity
Problem for bodybuilders who have high muscle
117
What an we use instead of BMI
Waist circumference
118
Fundamentally what is obesity caused by
Consuming more calories than you use
119
How many calories in a pound of weight
3500
120
How many calories in 1g of fat
9 calories
121
What is your basal metabolic rate
The amount of calories your body uses just to stay alive
122
How many calories in 1g of carbohydrates
4 calories
123
How many calories in 1g of protein
4 cals
124
How many people were found to be overweigh
1.9 billion
125
How many people were found to be obese
650 million
126
How much does obesity cost to the NHS
£6.1 billion
127
How can you manage obesity
Weight loss even in modest reduction
128
Is obesity only caused by diet
no it is multifactorial
129
Which three main factors affect obesity
1. Lack of physical activity
2. Dietary habits
3. other factors eg genetics, smoking and medication
130
List som health implications of obesity
1. Reduced life expectancy
2. Diabetes mellitus
3. Hyper tension, heart failure
4. Coronary heart disease
5. Obstructive sleep apnoea
6. Dyspnoea
7. Psychosocial
8. Osteoarthritis
9. Stress urinary incontinence
10. Menstrual dysfunction and reduced fertility
11. Cancer
12. Gastro-oesophageal reflux
13. Non-alcoholic fatty liver disease
131
By how much can obesity reduce your life expectancy
7-13 years
132
How can obesity lead to dyspnoea
physical restriction of weight on the thorax limits expansion, and abdominal mass impeding the diaphragm. Also, increased oxygen demands of increased tissue mass
133
How can obesity contribute to Obstructive Sleep Apnoea (OSA)
repeated collapse of the upper airway (in the pharynx) which results in an occluded airway for 10-15seconds (or longer)
134
What can Obstructive Sleep Apnoea (OSA) lead to
can mean a person never feels like they have a good nights sleep and subsequently increased fatigue levels during the day
135
Would we refer to patients as obese during communication
no use Increased body habitus
136
What considerations do we need to take as a dentist if we know our paint struggles with obesity
1. Access to the building
2. Safe weight limit of dental Chris
3. They may have excess soft tissues around the head and neck
4. Prescribing drugs
5. Long procedures may lead to pressure sores
6. Increased prevalence of GORD
137
What is the safe weight limit of dental chairs
140 kg
| 22 stones
138
What might be more difficult to do in patients who may be obese
Sedation and GA
139
What considerations do we need to take in patients who are obese if they have a medical emergency
1. IM needles may not reach muscle
2. Difficult to provide effective CPR
3. Airway management and iV access can be difficult
