Endocrinology Flashcards Preview

IHD Part 2 306 > Endocrinology > Flashcards

Flashcards in Endocrinology Deck (96)
Loading flashcards...
1

Diabetes for dentists: What parameters are used to diagnose diabetes?

Symptoms and random plasma glucose > 11.1 mmol/l
Fasting plasma glucose > 7 mmol/l
HbA1c > 48 mmol/mol
No symptoms - OGTT (75g glucose) fasting > 7 or 2h value > 11.1 mmol/l

2

Diabetes for dentists: What are the presenting features of diabetes?

Thirst
- osmotic activation of
hypothalamus

Polyuria
- osmotic diuresis

Weight loss (weeing sugar out) and fatigue
- dehydration (sugar isn't metabolising the cells)
- lipid and muscle loss

Pruritis vulvae and balanitis
- Vaginal candidiasis

Hunger- losing sugar calories

Blurred vision
- Altered acuity due to uptake of glucose/water into lens

nausea/ vomiting - breaking down fat to make ketones, blood becomes very acidic
Kussmaul breathing - build up of ketones in the blood

3

Diabetes for dentists: What are the clinical features of newly diagnosed type 1 diabetes?

Weight loss
moderate or large urinary ketones
Short history (weeks) of severe symptoms

Any 2 of these three features indicate Type 1 diabetes and are an indication for immediate insulin treatment at ANY age

Commonest age at diagnosis, 5-15y , but can occur at any age
Relatively rare (prevalence of 3/1000 among children and adolescents)
250,000 in the UK
An insulin deficiency disease (autoimmune destruction of the beta cell)
Treatment consists of restoring appropriate insulin concentrations

4

Diabetes for dentists: What are the aims of treatment in type 1 diabetes?

Relieve symptoms and prevent ketoacidosis

Prevent microvascular and macrovascular complications

Avoid hypoglycaemia

5

Diabetes for dentists: What microvascular complications are associated with diabetes?

Around 30% in the UK will develop diabetic nephropathy
- CV mortality withno nephropathy x2, but with nephropathy x30

Those with nephropathy tend to develop proliferative retinopathy and severe neuropathy (foot problems) with major effect on quality of life

6

Diabetes for dentists: What is the treatment of type 1 diabetes?

Insulin treatment
Twice daily mixture of short/medium acting insulin
Basal bolus, (once or twice daily medium acting insulin plus pre meal quick acting insulin)
Ability to judge carbohydrate intake
Awareness of blood glucose lowering effect of exercise

7

Diabetes for dentists: What are the symptoms of diabetes?

Shaking
fast heartbeat
hunger
irritable
headache
weakness fatigue
impaired vision
sweating

8

Diabetes for dentists: What is the dilemma for type 1 diabetics?

Setting higher glucose targets will reduce the risk of hypoglycaemia but increase the risk of diabetic complications

Setting lower glucose targets will reduce the risk of complications but increase the risk of hypoglycaemia

9

Diabetes for dentists: What is the pathogenesis of type 2 diabetes?

Increased thrombogenesis
Early hyperinsulinaemia
Hypertension
Central obesity
Insulin resistance
hyperglycaemia
abnormal lipids (low HDL cholesterol hypertriglyceridaemia)

all lead to 3-4x major cardiovascular risk

10

Diabetes for dentists: What happens to insulin in type 2 diabetes?

Insulin resistance (probably inherited) which demands increased production of insulin to maintain normal glucose levels before the development of diabetes

Progressive failure of insulin secretion

11

Diabetes for dentists: What are the complications of type 2 diabetes?

Macrovascular affect the majority and are often advanced at diagnosis
Myocardial infarction, stroke, peripheral vascular disease
Microvascular affect 20-25% at diagnosis and are modified by underlying vascular disease
Life expectancy is shortened at diagnosis by about 5-10 years

retinopathy, coronary heart disease, peripheral vascular disease, ulceration and amputation, nervous system neuropathy, cerebrovascular disease

12

Diabetes for dentists: What is the treatment of type 2 diabetes?

Ideally consists of weight loss and exercise (improve insulin resistance) which if substantial will reverse hyperglycaemia
but most of those with Type 2 diabetes have been making the ‘wrong’ lifestyle choices all their lives

At present, management usually consists of medication to control BP, blood glucose and lipids

metformin - a biguanide which reduces blood glucose by improving glucose uptake without increasing body weight and also reduces CV disease in the longterm. Now initial treatment of choice for all those with Type 2 diabetes
side effects - abdo pain and diarrhoea limit dose

or sulphonylurea: Act by stimulating release of insulin from pancreatic beta cells so can cause weight gain and hypoglycaemia, examples gliclazide, glibenclamide


Tight control of BP and lipids has a greater effect in reducing the risk of macrovascular disease (and reduces microvascular complications) and is usually easier to achieve than blood glucose control

diet - eat less and reduce refined carbohydrates

last resort - insulin, Insulin secretion declines progressively in Type 2 diabetes, over 50% will need insulin

13

Diabetes for dentists: What other drugs can be used for type 2 diabetes?

Or possibly pioglitazone,
Or a DPPIV inhibitor, e.g., sitagliptin
Or a gliflozin, e.g., empagliflozin
Or a incretin mimetic (injection), e.g., exenatide or liraglutide

14

Diabetes for dentists: What is diabetic ketoacidosis?

Hyperglycaemia (use capillary sample but confirm with lab test)
Venous bicarbonate less than 15 mmol/l
Ketones

15

Diabetes for dentists: What are the causes of diabetic ketoacidosis?

infections
omission of insulin
new diagnosis

16

Diabetes for dentists: who is at risk of HHS and HONK?

Poorly controlled Type 2 diabetes
Newly diagnosed Type 2 diabetes patients, often elderly

17

Diabetes for dentists: What are the symptoms of diabetic ketoacidosis?

Tachypnea
blood clots

18

Diabetes for dentists: What are the autonomic symptoms and signs of hypoglycaemia?

Sweating
Tremor
Palpitations
below 3.8mmol glucose - body starts to make adrenaline , can cause person to eat but may not be able to if it is in sleep

19

Diabetes for dentists: What are the neuroglycopenic symptoms and signs of hypoglycaemia?

Loss ofconcentration
Drowsiness
Anger / sadness
Confusion

20

Diabetes for dentists: What is the management of hypoglycaemia? 999 emergency

conscious:
oral glucose - fast acting (lucozade) need something long acting as well like sandwich
Check blood glucose after 10 mins (further IV/PO glucose if needed)
identify cause
re-educate
adopt measures to avoid hypos

unconscious:
glucagon 1 mg (IM) - will break down glycogen in the liver to glucose
IV glucose (100 mls 10% dextrose)
Check blood glucose after 10 mins (further IV/PO glucose if needed)
identify cause
re-educate
adopt measures to avoid hypos

21

Diabetes for dentists: How do you monitor diabetes?

Venous blood glucose
HbA1c
Capilliary blood glucose
Blood ketones
Urinary ketones
CGM/ libres

22

Diabetes for dentists: What are the links between diabetes and dentistry?

Increased rates of gingivitis / periodonitis (2-5 fold) / dental caries / candidiasis / endocarditis

Stress – both physical & emotional raises blood glucose levels

Beware of hypoglycaemic medications

Type 1 diabetes is autoimmune process, therefore Sjorgrens is more likely

Some studies suggest improvements in glycaemic control after periodontal intervention

Dentists can help in the early recognition of T2DM (and rarely T1DM)

23

Endocrinology disease pathology: What is an endocrine gland?

One whose secretions (hormones) pass
directly into the blood stream

24

Endocrinology disease pathology: What are hormones?

Influence target organs by binding to receptors

Receptors may be on cell surface or intranuclear

25

Endocrinology disease pathology: What are exocrine glands?

One whose secretions pass into the gut, respiratory tract or exterior of the body

26

Endocrinology disease pathology: What is a feedback mechanism?

low levels - produce more
once levels rise, feedback to stop producing more

27

Endocrinology disease pathology: What clinical symptoms can be due to endocrine disease?

Underproduction / non-functioning

Overproduction

Mass

Malignancy

28

Endocrinology disease pathology: Describe the hypothalamic pituitary axis

Hypothalamus - releasing hormones to pituitary which sends stimulating hormones to thyroid/adrenal - negative feedback to the hypothalamus

29

Endocrinology disease pathology: What is the normal weight and cortex proportion of an adrenal gland

4g

90% of total weight

30

Endocrinology disease pathology: What is Waterhouse - friderichsen syndrome?

defined as adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection. Typically, it is caused by Neisseria meningitidis