Diabetes Mellitus Flashcards
(28 cards)
What is diabetes mellitus?
Metabolic condition which is characterised by abnormal glucose regulation, resulting in hyperglycaemia- can be type 1 or type 2.
What is a potential consequence of chronic hyperglycaemia?
Microvascular complications- capillaries which supply nutrients to skin, nerves and other parts of the body.
Macrovascular- heart attack and stroke.
Increases risk of atherosclerosis.
What tests are used for Diabetes Mellitus?
Random plasma glucose- greater than 11.1mmol/L on 2 occasions, suggests diabetes.
Glucose tolerance test- indicated if fasting sample indicates impaired fasting glucose.
HbA1C- greater than 48 mol/mol (6.5%).
What is HbA1c and why is it a good diagnostic measure of diabetes mellitus?
Glycoylated haemoglobin- measures how much haemoglobin has glucose stuck to it.
This increases over time and with the glucose concentration within the blood, gives a good indication of the past few weeks.
What is type 1 diabetes mellitus?
Insulin deficiency- autoimmune destruction of pancreatic beta cells, causes a lack of insulin to be produced.
What are the consequences of insulin deficiency in T1DM?
Hyperglycaemia
Ketoacidosis- body cells cannot access glucose for metabolism so they start to metabolise fat which results in ketones as the end products.
Ketones are acidic- build up in the blood.
What are the signs and symptoms of T1DM?
Polyuria
Polydipsia
Tiredness
Weight loss
Acute presentation- hyperglycaemia with diabetic symptoms, ketoacidosis.
What is T2DM?
Defective and delayed insulin secretion and abnormal postprandial suppression of glucagon- the glucose load within the blood does not suppress glucagon- so glucagon will continue to make glycogen.
Insulin resistance.
Describe the glucose-insulin-glucagon life cycle?
Glucose is taken in via the diet, insulin is released in response to this.
Glucose is then taken up by the tissues.
Glucose is used up here, therefore, glucose coenntration in the blood decreases.
Glucagon is produced, which causes the release of glycogen from the liver- until more glucose is taken in through the diet and the cycle starts again.
What factors encompass T2DM?
Inadequate B cell response to an increased glucose load.
Elevated basal insulin levels.
Failure of gluconeogenesis suppression.
Insulin stimulated glucose uptake is reduced.
What are the systemic effects fo T2DM?
Impaired glucose tolerance
Hyperinsulinamemia
Hypertension
Obesity with abdominal distribution
Dyslipidaemia
Does family history play a role in diabetes?
In T2, yes. In T1, potentially.
What guidance may be useful in the diagnosis and management of diabetes?
NICE guidelines- Diabetes in children and young people, Diabetes in adults.
What is the typical management of T1DM?
Insulin from diagnosis
- either basal bolus injections- single long lasting insulin, provides background for the whole day to prevent ketoacidosis, then take some doses of short acting insulin to allow meals and exercise.
- Split-mixed- fewer injections are needed, this insulin contains rapid acting and medium insulin so that the blood sugars are maintained less well but adequately.
How is insulin delivered?
Subcutaneous injection.
What is the basis of T1DM management?
Nutritional advice.
Exercise
Monitoring glucose levels to determine insulin dosage.
What methods are available for glucose monitoring?
Continuous glucose monitoring- attached to the skin, patient will get an alert if the blood sugar goes above the target range.
Closed loop glucose monitoring- monitor is attached to an insulin pump, which will change the levels of insulin injected subcutaneously depending on the glucose levels in the blood.
What level of HbA1C should the patient be aiming for?
6-10%, not any higher than 10%.
What is the management for T2DM?
Lifestyle changes- weigh loss, diet restriction.
Medication- metformin, DDP-4 inhibitors, GLP-1 mimetic, sulphonylureas.
Surgery- to help weight loss.
Describe the method of action of diabetes medication.
Metformin- enhances cell insulin sensitivity.
DDP-4 inhibitors (gliptin)- block the enzyme metabolising incretin, improves insulin response to glucose.
GLP-1 mimetics- increase the level of incretin.
Sulphonylureas- increase pancreatic insulin secretion.
Under what circumstances might someone be on insulin if they have T2DM?
Patient is unable to maintain glycemic control with behavioural changes, body weight reduction and oral hypoglycaemic agents.
Describe some of the complications of DM.
Cardiovascular risk- caused by macrovascular and microvascular changes.
Infection risk
Reduced ability for wound healing
Neuropathy- caused by changes in the nutrient supply to the autonomic nerves by the microvascular changes.
Retinopathy
Angina, MI, atherosclerosis
What factors do you need to consider with DM in relation to dentistry?
Need to work appointments around meal times- early to mid morning is best.
Stress hormones released during surgery can aggravate the diabetes control.
Poor wound healing.
Infection risk.
Be aware of diabetic emergencies.
All children with T1DM should be placed on the enhanced pathway for caries prevention.
Children with medical conditions will have increased anxiety.
Patients can become fatigued with hospital care.
In Children with T1DM, who may be involved in the MDT for these patients?
Paediatric endocrinologist
Paediatric diabetes specialist nurse
Paediatric dietician
Clinical psychologist
