87 Questions
What is the primary function of glucose in the body?
To act as an essential energy substrate for RBCs and nerve cells
What is the effect of insulin on blood glucose levels?
It lowers blood glucose levels
What is the process called when glucagon, cortisol, catecholamines, and growth hormones increase blood glucose levels?
Hyperglycaemia
Where is glucose stored after a meal?
In the liver and fat
What is the mechanism of action of insulin?
Insulin is a polypeptide hormone that promotes glucose uptake into cells
What is the primary function of glucose control?
To maintain blood sugar levels, provide energy when required, and maintain stores of energy
What percentage of the diet should be composed of carbohydrates?
50%
When are oral hypoglycaemics recommended to treat diabetes mellitus?
When diet control alone is not providing sufficient recovery
What is the effect of Suphonylureas on insulin secretion?
They increase beta cell insulin secretion
What is the characteristic of the brain's glucose absorption?
It can absorb glucose from blood at its own will.
Why is Glibenclamide avoided in elderly and renal failure patients?
Because it is long-acting and has renal excretion
What is the effect of Metformin on gut glucose absorption?
It decreases gut glucose absorption
Which of the following hormones promotes gluconeogenesis and increases glucose levels?
Growth hormone
What is the main macro-vascular complication of diabetes?
Accelerated atheroma
What is the primary reason for hyperglycaemia in diabetes mellitus?
Imbalance of glucose
What is the role of insulin in the body?
To convert glucose to glycogen
What is the effect of diabetes on wound healing in the oral cavity?
It impairs wound healing
What is the difference between type 1 and type 2 diabetes in terms of age of diagnosis?
Type 1 is diagnosed in patients between 10-20 years, while type 2 is diagnosed in patients over 40 years.
What is the effect of poorly controlled diabetes on polymorph function?
It reduces polymorph function
What is the cause of type 1 diabetes?
Viral infection in HLA DR3/DR4 individuals
Why are diabetic control procedures put in place prior to surgery with diabetes patients?
To minimize the risk of infections and hypo/hyperglycaemia
What is the long-term complication of diabetes mellitus that affects the kidneys?
Kidney failure
What is the diet adjustment for someone with diabetes mellitus in terms of fat intake?
Reduce fat intake to 30-35% of total energy intake
What is the effect of glucagon on blood glucose levels?
Increases blood glucose levels
What is the term for the condition characterized by chronic hyperglycaemia resulting from relative insulin deficiency, peripheral tissue resistance, or both?
Diabetes mellitus
What is the most common cause of Cushing's syndrome?
Pituitary adenoma
What is a classic diagnostic sign of Cushing's syndrome?
Increase in MSH
What is the purpose of the dexamethasone suppression test?
To suppress endogenous serum cortisol
What is the primary mechanism by which cortisol contributes to periodontal disease?
Inhibiting white blood cell migration
What is Addison's disease also known as?
Hypoadrenalism
What is a potential complication of long-term steroid therapy?
All of the above
What is one of the dental problems that can be caused by diabetes?
Periodontal disease
Why are insulins used as injectables?
Because they are small proteins that can't withstand gastric acid transit
What is the main difference between the three types of insulin?
Their speed of action
Which of the following is NOT a way to measure blood glucose levels?
Blood pressure test
What is acute hypoglycaemia caused by?
An imbalance of insulin and glucose in the body
What is a common symptom of acute hypoglycaemia?
Hunger
How is acute hypoglycaemia diagnosed?
Through a fingerprick BM and lab serum glucose
What is the recommended treatment for a conscious person with acute hypoglycaemia?
Rapid ingestion of sugar
What is one of the common causes of diabetic ketoacidosis (DKA)?
Missed insulin or relative under-dosing error
What should never be administered to a person with suspected acute hypoglycaemia?
Insulin
Why should insulin not be stopped when a patient is ill and off food?
To prevent diabetic ketoacidosis
What is the primary cause of diabetic ketoacidosis?
Insulin deficiency
What is a key clinical feature of diabetic ketoacidosis?
Profound dehydration
What is expected to be seen in the test results of a diabetic ketoacidosis patient?
High blood sugar levels and high ketones
What is the primary goal of treatment for diabetic ketoacidosis?
Restore fluid and electrolyte losses
What is Hyperosmolar Non-Ketotic State (HONK)?
A severe hyperglycemia without significant ketosis
What is the risk of poor diabetic control in a pregnant woman?
All of the above
What is the function of the adrenal cortex?
Producing steroid hormones
What is the effect of glucocorticoids on water excretion?
Initiates diuresis
What is Cushing's syndrome caused by?
Persistent and inappropriately raised plasma cortisol levels
What is the primary cause of an Addisonian crisis?
Inadequate cortisol levels
What is the effect of cortisol on adrenaline in the vascular shunting exercise?
Cortisol potentiates systemic adrenaline
What is the primary investigation used to diagnose Addison's disease?
Serum chemistry
What is the medication used to manage Addison's disease?
Hydrocortisone and Fludrocortisone
What is the consequence of an Addisonian crisis?
Hypovalaemic shock
What is the cause of secondary hypoadrenalism?
Hypothalamic-pituitary axis disease
What is the primary effect of a growth hormone deficiency in childhood?
Pituitary dwarf
What is the primary mechanism by which growth hormone acts?
Via Insulin like Growth Factor (IGF-1) synthesised in the liver
What is the characteristic feature of acromegaly?
Enlarging head, hands and feet
What is the primary site of tumour in acromegaly?
Anterior pituitary
What is the primary investigation used to diagnose acromegaly?
Glucose tolerance test
What is the primary management of acromegaly?
All of the above
What is the primary mechanism of action of thyroid hormone?
Under control of hypothalamus via TRF
What is the primary cause of hypothyroidism?
Primary disease of thyroid tissue
What is the primary clinical feature of hypothyroidism?
Coldness
What is the primary management of hypothyroidism?
Lifelong replacement therapy with T4
What is the most common cause of hyperthyroidism?
Grave's disease
What is the effect of IgG autoantibody on TSH receptors in Grave's disease?
Stimulates thyroxine production
What is the primary role of parathyroid hormone in the body?
Regulates serum calcium levels
What is the typical location of the lower pair of parathyroid glands?
Below the upper pair of parathyroid glands
What is the primary cause of primary hyperparathyroidism?
Unstimulated PTH excess by adenoma in the parathyroid gland
What is the characteristic feature of the skull in primary hyperparathyroidism?
All of the above
What is the treatment for primary hyperparathyroidism?
Resection of the adenoma
What is the effect of hyperparathyroidism on the kidneys?
Increased renal excretion of calcium
What is the characteristic feature of goitre?
Enlargement of the thyroid gland
What is the cause of dysphagia or stridor in goitre?
Pressure on the larynx
What is the primary issue with Addisonian patients in stressful situations?
They cannot produce enough cortisol to accompany the adrenaline.
What is recommended for a steroid-dependent Addison's disease patient before major dental surgery like an extraction?
100mg hydrocortisone IM just before anaesthesia.
What is the primary function of mineralocorticoids?
They promote renal sodium reabsorption and potassium excretion.
What is another term for Conn's syndrome?
Hyperaldosteronism.
What are three consequences of primary adrenal adenoma as a result of Conn's syndrome?
Excess fluid retention, hypokalaemia, and secondary hypertension.
What is the mechanism of action of congenital adrenal hyperplasia?
Accumulation of 17-hydroxylase progesterone, leading to androgen production.
What group of people is more commonly affected by congenital adrenal hyperplasia?
Infertile and hirsute young hypotensive females with salt-losing kidneys.
What can occur to young boys with congenital adrenal hyperplasia?
Precocious puberty.
What is the recommended treatment for Conn's syndrome due to adrenal hyperplasia?
Hypertension management using spironolactone.
What is the primary cause of secondary hyperaldosteronism from Conn's syndrome?
Excess renin production.
Study Notes
Glucose and Insulin
- Glucose is an essential energy substrate for red blood cells and nerve cells (nerves use ketones in starvation).
- Insulin:
- Lowers blood glucose levels (hypoglycaemic)
- Causes glucose to be absorbed into cells
- Promotes fat and protein synthesis
Glucose Regulation
- 4 factors increase blood glucose levels (hyperglycaemic):
- Glucagon
- Cortisol
- Catecholamines
- Growth hormone
- 2 ways glucose is retrieved in fasting:
- Glyconeogenesis from liver
- Gluconeogenesis from amino acids (manufacture of sugar by amino acids)
Glucose Control Functions
- 3 functions of glucose control:
- Maintain blood sugar levels
- Maintain energy stores
- Provide energy when required
- Brain is different in glucose control:
- Can absorb glucose from blood at its own will
- Not subject to insulin control
- Vulnerable to conditions that alter blood sugar levels
Diabetes Mellitus
- A group of conditions characterized by chronic hyperglycaemia resulting from relative insulin deficiency, peripheral tissue resistance, or both.
- Diabetes mellitus classified into:
- Type 1 (insulin dependent) - hormone failure (insulin)
- Type 2 (insulin independent) - insulin is made, but tissues are resistant to its effect
- Differences between type 1 and type 2 diabetes:
- Epidemiology: type 1 - younger patients, type 2 - older patients
- Onset: type 1 - acute, type 2 - chronic
- Habitus: type 1 - lean, type 2 - often obese
- Ethnicity: type 1 - often European, type 2 - all racial groups
- Family history: type 1 - uncommon, type 2 - frequent
- HLA system: type 1 - DR3/DR4 in over 90% of patients, type 2 - no HLA links
- Risk to identical twin: type 1 - 30-35%, type 2 - over 90%
- Aetiology: type 1 - autoimmune/viral, type 2 - obesity
- Clinical: type 1 - always requires insulin, type 2 - diet/oral hypoglycaemics
- Long-term complications of diabetes:
- Neurological conditions (e.g. dizziness)
- Diabetic ketoacidosis
- Autonomic symptoms (e.g. palpitations, sweats)
- Oral candidiasis
- Increased risk of MI/Stroke/kidney failure/retinal loss of vision/increased risk of infection/salivary gland dysfunctional flow/BMS/lichen planus/more active caries/traumatic ulcers
Diabetes Treatment
- Diet adjustments:
- Fat reduced to 30-35% of total energy intake (mainly unsaturated)
- Protein reduced to 10-15%
- Carbohydrate = 50% (complex carbohydrates like pasta are absorbed slowly and lessen sugar level swings)
- Oral hypoglycaemics recommended to treat diabetes mellitus:
- Used if diet control alone is not providing sufficient recovery
- Examples: sulphonylureas, biguanides (e.g. metformin)
Insulins
- Used as injectables as a small protein to withstand gastric acid transit
- 3 main types of insulin:
- Actrapid (fast acting, pure - onset 15-60 minutes, duration 4-6 hours)
- Monotard (intermediate acting - onset 1-2 hours, duration 12-24 hours)
- Mixtard (mixture of long and short acting)
Diabetes and Dentistry
- Diabetes can cause:
- Periodontal disease
- Xerostomia
- Risk of ischemic heart disease
- Oral candidosis if uncontrolled can lead to angular stomatitis
- Peripheral autonomic neuropathy may cause paraesthesia in the mouth and salivary gland swelling as well as orthostatic hypotension
- Burning mouth sensation
- Dry mouth – dehydration due to polyuria
Test your knowledge of glucose's role in the body, insulin's effects on blood glucose levels, and the processes that increase or decrease glucose levels. Learn how glucose is stored and utilized by the body.
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