Podcast
Questions and Answers
What is the primary function of glucose in the body?
What is the primary function of glucose in the body?
- To store energy for the liver
- To provide energy for muscle cells
- To act as an essential energy substrate for RBCs and nerve cells (correct)
- To regulate hormone production
What is the effect of insulin on blood glucose levels?
What is the effect of insulin on blood glucose levels?
- It stabilizes blood glucose levels
- It lowers blood glucose levels (correct)
- It has no effect on blood glucose levels
- It increases blood glucose levels
What is the process called when glucagon, cortisol, catecholamines, and growth hormones increase blood glucose levels?
What is the process called when glucagon, cortisol, catecholamines, and growth hormones increase blood glucose levels?
- Hypoglycaemia
- Gluconeogenesis
- Glycogenolysis
- Hyperglycaemia (correct)
Where is glucose stored after a meal?
Where is glucose stored after a meal?
What is the mechanism of action of insulin?
What is the mechanism of action of insulin?
What is the primary function of glucose control?
What is the primary function of glucose control?
What percentage of the diet should be composed of carbohydrates?
What percentage of the diet should be composed of carbohydrates?
When are oral hypoglycaemics recommended to treat diabetes mellitus?
When are oral hypoglycaemics recommended to treat diabetes mellitus?
What is the effect of Suphonylureas on insulin secretion?
What is the effect of Suphonylureas on insulin secretion?
What is the characteristic of the brain's glucose absorption?
What is the characteristic of the brain's glucose absorption?
Why is Glibenclamide avoided in elderly and renal failure patients?
Why is Glibenclamide avoided in elderly and renal failure patients?
What is the effect of Metformin on gut glucose absorption?
What is the effect of Metformin on gut glucose absorption?
Which of the following hormones promotes gluconeogenesis and increases glucose levels?
Which of the following hormones promotes gluconeogenesis and increases glucose levels?
What is the main macro-vascular complication of diabetes?
What is the main macro-vascular complication of diabetes?
What is the primary reason for hyperglycaemia in diabetes mellitus?
What is the primary reason for hyperglycaemia in diabetes mellitus?
What is the role of insulin in the body?
What is the role of insulin in the body?
What is the effect of diabetes on wound healing in the oral cavity?
What is the effect of diabetes on wound healing in the oral cavity?
What is the difference between type 1 and type 2 diabetes in terms of age of diagnosis?
What is the difference between type 1 and type 2 diabetes in terms of age of diagnosis?
What is the effect of poorly controlled diabetes on polymorph function?
What is the effect of poorly controlled diabetes on polymorph function?
What is the cause of type 1 diabetes?
What is the cause of type 1 diabetes?
Why are diabetic control procedures put in place prior to surgery with diabetes patients?
Why are diabetic control procedures put in place prior to surgery with diabetes patients?
What is the long-term complication of diabetes mellitus that affects the kidneys?
What is the long-term complication of diabetes mellitus that affects the kidneys?
What is the diet adjustment for someone with diabetes mellitus in terms of fat intake?
What is the diet adjustment for someone with diabetes mellitus in terms of fat intake?
What is the effect of glucagon on blood glucose levels?
What is the effect of glucagon on blood glucose levels?
What is the term for the condition characterized by chronic hyperglycaemia resulting from relative insulin deficiency, peripheral tissue resistance, or both?
What is the term for the condition characterized by chronic hyperglycaemia resulting from relative insulin deficiency, peripheral tissue resistance, or both?
What is the most common cause of Cushing's syndrome?
What is the most common cause of Cushing's syndrome?
What is a classic diagnostic sign of Cushing's syndrome?
What is a classic diagnostic sign of Cushing's syndrome?
What is the purpose of the dexamethasone suppression test?
What is the purpose of the dexamethasone suppression test?
What is the primary mechanism by which cortisol contributes to periodontal disease?
What is the primary mechanism by which cortisol contributes to periodontal disease?
What is Addison's disease also known as?
What is Addison's disease also known as?
What is a potential complication of long-term steroid therapy?
What is a potential complication of long-term steroid therapy?
What is one of the dental problems that can be caused by diabetes?
What is one of the dental problems that can be caused by diabetes?
Why are insulins used as injectables?
Why are insulins used as injectables?
What is the main difference between the three types of insulin?
What is the main difference between the three types of insulin?
Which of the following is NOT a way to measure blood glucose levels?
Which of the following is NOT a way to measure blood glucose levels?
What is acute hypoglycaemia caused by?
What is acute hypoglycaemia caused by?
What is a common symptom of acute hypoglycaemia?
What is a common symptom of acute hypoglycaemia?
How is acute hypoglycaemia diagnosed?
How is acute hypoglycaemia diagnosed?
What is the recommended treatment for a conscious person with acute hypoglycaemia?
What is the recommended treatment for a conscious person with acute hypoglycaemia?
What is one of the common causes of diabetic ketoacidosis (DKA)?
What is one of the common causes of diabetic ketoacidosis (DKA)?
What should never be administered to a person with suspected acute hypoglycaemia?
What should never be administered to a person with suspected acute hypoglycaemia?
Why should insulin not be stopped when a patient is ill and off food?
Why should insulin not be stopped when a patient is ill and off food?
What is the primary cause of diabetic ketoacidosis?
What is the primary cause of diabetic ketoacidosis?
What is a key clinical feature of diabetic ketoacidosis?
What is a key clinical feature of diabetic ketoacidosis?
What is expected to be seen in the test results of a diabetic ketoacidosis patient?
What is expected to be seen in the test results of a diabetic ketoacidosis patient?
What is the primary goal of treatment for diabetic ketoacidosis?
What is the primary goal of treatment for diabetic ketoacidosis?
What is Hyperosmolar Non-Ketotic State (HONK)?
What is Hyperosmolar Non-Ketotic State (HONK)?
What is the risk of poor diabetic control in a pregnant woman?
What is the risk of poor diabetic control in a pregnant woman?
What is the function of the adrenal cortex?
What is the function of the adrenal cortex?
What is the effect of glucocorticoids on water excretion?
What is the effect of glucocorticoids on water excretion?
What is Cushing's syndrome caused by?
What is Cushing's syndrome caused by?
What is the primary cause of an Addisonian crisis?
What is the primary cause of an Addisonian crisis?
What is the effect of cortisol on adrenaline in the vascular shunting exercise?
What is the effect of cortisol on adrenaline in the vascular shunting exercise?
What is the primary investigation used to diagnose Addison's disease?
What is the primary investigation used to diagnose Addison's disease?
What is the medication used to manage Addison's disease?
What is the medication used to manage Addison's disease?
What is the consequence of an Addisonian crisis?
What is the consequence of an Addisonian crisis?
What is the cause of secondary hypoadrenalism?
What is the cause of secondary hypoadrenalism?
What is the primary effect of a growth hormone deficiency in childhood?
What is the primary effect of a growth hormone deficiency in childhood?
What is the primary mechanism by which growth hormone acts?
What is the primary mechanism by which growth hormone acts?
What is the characteristic feature of acromegaly?
What is the characteristic feature of acromegaly?
What is the primary site of tumour in acromegaly?
What is the primary site of tumour in acromegaly?
What is the primary investigation used to diagnose acromegaly?
What is the primary investigation used to diagnose acromegaly?
What is the primary management of acromegaly?
What is the primary management of acromegaly?
What is the primary mechanism of action of thyroid hormone?
What is the primary mechanism of action of thyroid hormone?
What is the primary cause of hypothyroidism?
What is the primary cause of hypothyroidism?
What is the primary clinical feature of hypothyroidism?
What is the primary clinical feature of hypothyroidism?
What is the primary management of hypothyroidism?
What is the primary management of hypothyroidism?
What is the most common cause of hyperthyroidism?
What is the most common cause of hyperthyroidism?
What is the effect of IgG autoantibody on TSH receptors in Grave's disease?
What is the effect of IgG autoantibody on TSH receptors in Grave's disease?
What is the primary role of parathyroid hormone in the body?
What is the primary role of parathyroid hormone in the body?
What is the typical location of the lower pair of parathyroid glands?
What is the typical location of the lower pair of parathyroid glands?
What is the primary cause of primary hyperparathyroidism?
What is the primary cause of primary hyperparathyroidism?
What is the characteristic feature of the skull in primary hyperparathyroidism?
What is the characteristic feature of the skull in primary hyperparathyroidism?
What is the treatment for primary hyperparathyroidism?
What is the treatment for primary hyperparathyroidism?
What is the effect of hyperparathyroidism on the kidneys?
What is the effect of hyperparathyroidism on the kidneys?
What is the characteristic feature of goitre?
What is the characteristic feature of goitre?
What is the cause of dysphagia or stridor in goitre?
What is the cause of dysphagia or stridor in goitre?
What is the primary issue with Addisonian patients in stressful situations?
What is the primary issue with Addisonian patients in stressful situations?
What is recommended for a steroid-dependent Addison's disease patient before major dental surgery like an extraction?
What is recommended for a steroid-dependent Addison's disease patient before major dental surgery like an extraction?
What is the primary function of mineralocorticoids?
What is the primary function of mineralocorticoids?
What is another term for Conn's syndrome?
What is another term for Conn's syndrome?
What are three consequences of primary adrenal adenoma as a result of Conn's syndrome?
What are three consequences of primary adrenal adenoma as a result of Conn's syndrome?
What is the mechanism of action of congenital adrenal hyperplasia?
What is the mechanism of action of congenital adrenal hyperplasia?
What group of people is more commonly affected by congenital adrenal hyperplasia?
What group of people is more commonly affected by congenital adrenal hyperplasia?
What can occur to young boys with congenital adrenal hyperplasia?
What can occur to young boys with congenital adrenal hyperplasia?
What is the recommended treatment for Conn's syndrome due to adrenal hyperplasia?
What is the recommended treatment for Conn's syndrome due to adrenal hyperplasia?
What is the primary cause of secondary hyperaldosteronism from Conn's syndrome?
What is the primary cause of secondary hyperaldosteronism from Conn's syndrome?
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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
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