2. Diabetes Mellitus

Question 1

What are that pathophysiologies of diabetes?

Answer 1

• Deficiency of insulin - secondary to destruction of beta (islet) cells.
• Issues with insulin binding at receptors - faulty receptors, antibodies to insulin or receptors
• Result - hyperglycemic state

Question 2

What are the short and long term effects of hyperglycemia?

Answer 2

• Short term - Polyphagia, polyuria, polydipsia
  
  • Ketoacidosis or hyperosmotic - diabetic coma
• Long term
  
  • Microangiopathy
  • Deposition of by-products in tissues
  • Delayed healing/susceptible to infections

Question 3

What should the fasting blood glucose be?

Answer 3

>126mg/100mL

Question 4

What should the 2hr post-prandial glucose test be?

Answer 4

• Oral glucose tolerance test (75g)
• >200mg/100mL

Question 5

What’s the target HbA1C level?

Answer 5

<7% in well-controlled diabetics

>7 = uncontrolled

Question 6

What are the oral manifestations of diabetes?

Answer 6

• Xerostomia
• Infections (bacterial, viral, fungal)
• Poor wound healing
• Increased incidence/severity of
  
  • Caries, gingivitis, periodontal disease, periapical abscesses, burning mouth symptoms

Question 7

Is there a bleeding risk for patients with diabetes?

Answer 7

Nope - no significant risk

Question 8

Why would diabetics have a susceptibility to infection?

Answer 8

• Decreased wound healing
• Increased susceptibility for infection
• Diabetic control is affected when the patient has an infection

Question 9

Epinephrine can cause an increase in blood glucose (T/F)?

Answer 9

True

Question 10

How can well-controlled diabetics without any complications tolerate dental care?

Answer 10

Normally

Question 11

What are good risk preventions for diabetics in the dental office?

Answer 11

• Morning appts
• Pts eat and take normal med dosage
• Glucometer present
• Have fast acting carbs on hand in case of hypoglycemia during procedure
  
  • OJ, cake icing, etc

Question 12

When should you refer for a medical evaluation and follow up?

Answer 12

• Patients who exhibit:
  
  • Diabetic complications
  • Poor glycemic control (A1c, glucose levels)
  • Frequent episodes of insulin shock
  • Have not seen their physician regularly
• Only emergency care should be provided

Question 13

When should you take the blood glucose reading?

Answer 13

At the beginning of the initial visit

For uncontrolled patients - repeat at follow-up visits

Question 14

When should you use antibiotics in diabetic patients?

Answer 14

• Postoperatively - for uncontrolled patients who have undergone dental surgery.