Endocrine Disorders and Diabetes Management Quiz

Endocrine Diseases & Diabetes - Lecture Notes

• Lecture date: 24th January 2025
• Presenters: Hannah Barrow, Khadeeja Saeed, Georgina Prosser
• Topic focus: Endocrine diseases, specifically diabetes and its impact on dental health and patient management.

Aims & Learning Objectives

• Students should be able to confidently explain the endocrine system and its role.
• Understand and define different endocrine diseases.
• Explain the pathophysiology of diabetes.
• Describe how to manage medical emergencies involving diabetes in patients.
• Discuss how dental treatments could be affected by conditions like diabetes.
• Describe the medications patients might be on and their relevance to dentistry.

Why Know About Endocrine Disease?

• Endocrine disorders are diverse and affect dental health.
• Diabetes (predominantly type 2) is prevalent globally.
• The number of people with diabetes is increasing.
• Endocrine patients are often on various medications (some long-term).
• Dental professionals need to recognize and manage Addison's crisis and manage patients with high and/or low blood sugar.

GDC Preparing for Practice

• Dental hygienists and therapists will be able to:
  • Describe relevant physiology for patient management.
  • Describe the properties of medicines and therapeutic agents.
  • Explain the impact of conditions (like diabetes) on the patients.
  • Recognize and manage medical emergencies.

Structure of Lecture

• Part 1: The Endocrine System: This section reviews the endocrine system, including gland function, hormones and how various parts of the system interact with each other.
• Part 2: How Endocrine Diseases Occur: Defines endocrine diseases, explains their pathophysiology, and identifies possible symptoms.
  • Common examples of endocrine disorders to cover: Acromegaly, Adrenal insufficiency, Hyperthyroidism/Hypothyroidism, Hyperpituitarism/Hypopituitarism, Polycystic ovary syndrome, Diabetes
• Part 3: Diabetes: This section focuses on Diabetes; including aetiology, pathophysiology, symptoms, treatments and implications for dentistry.
• Part 4: Dental Management of Patients with Endocrine Disease: Includes specific considerations regarding diabetes and patient management, including specific questions to ask in consultations.
  • Discusses patient management, clinical considerations, risk factors and prevention of diseases, understand medical emergencies related to diabetes
• Group discussion: A group discussion session allows for reflective learning about the topic.

Specific Endocrine Disorders

• Acromegaly: A rare condition where the pituitary gland produces too much growth hormone, often due to a tumour; characterized by an increase in size of bones, cartilage, body organs, and other tissues, with associated craniofacial features, (e.g. larger nose, ears, hands, and feet).
• Adrenal insufficiency (Addison's disease): A rare autoimmune disease where adrenal glands do not produce enough cortisol (stress hormone); possible symptoms include fatigue, muscle weakness, weight loss and abdominal pain, and requires careful management in stressful situations due to potential for adrenal crisis.
• Cushing's disease: An endocrine disorder characterized by excessive cortisol production, often attributed to long-term steroid medication use.
• *Hyperthyroidism:*Thyroid gland produces too much thyroxine, which raises metabolism and causes symptoms like bulging eyes and a goiter; often autoimmune (Grave's disease).
• Hypothyroidism: Thyroid gland produces too little thyroxine, making metabolism fall, and often diagnosed with symptoms such as fatigue, constipation, weight gain etc and with autoimmune reasons
• Hyper/Hypopituitarism: Conditions related to the pituitary gland's overactivity or underactivity, commonly leading to irregularities in other hormones' production and imbalances.
• Polycystic ovary syndrome (PCOS): A hormonal imbalance in women, characterized by excess facial hair, weight gain and irregular periods
• Diabetes: Diabetes is a chronic disease where the pancreas doesn't produce enough insulin (Type 1) or the body's cells don't respond effectively to insulin (Type 2), leading to high blood sugar. A person's blood sugars need to be kept under control to avoid further complications.
• Gestational diabetes: Diabetes developing during pregnancy, often linked to hormonal changes causing insulin resistance and affecting the mother and child.

Pathophysiology of Diabetes

• Insulin regulates blood glucose levels
• High blood sugar over time can damage various organs.
• In Type 1 diabetes, the pancreas doesn't produce insulin.
• In Type 2 diabetes, the body doesn't use insulin effectively.

Complications

• Hypoglycaemia: Low blood sugar, characterized by symptoms like shaking, confusion, and loss of consciousness
• Adrenal crisis: A life-threatening complication of Addison's disease, which causes low cortisol and needs prompt medical attention
• Long-term complications of uncontrolled diabetes can include:
  • Cardiovascular disease
  • Cerebrovascular disease
  • Peripheral vascular disease
  • Neuropathy
  • Retinopathy
  • Nephropathy
  • Diabetic eye disease
  • Foot ulcers
  • periodontal disease

Dental Management

• Asking patients about their diagnosis history can greatly enhance medical care and aid with management planning

• Key questions for consultation to assess diabetes management include:

  • When was the diagnosis made?
  • What are their medications and their frequency?
  • Have they experienced episodes of hypo/hyperglycaemia?
  • How frequently do patients check their blood sugar levels, and are these well-controlled?
  • How frequently do they see their doctor?
  • Important to obtain a detailed social history.

• Update medical history before treatment

• Check blood sugars before treatment

• Emphasize prevention of periodontal disease.

• Be aware of potential risks of dental surgery (delayed healing and dental decay).

• Understand medical emergencies (hypo/hyperglycaemia, adrenal crisis); be versed in proper management of these according to GDC guidelines.

Additional Information

• Further reading: Links to external websites for additional information.
• Treatments: Lists of medications (such as insulin types) and treatments for both Type 1 and 2 Diabetes.