Ch 49 Diabetes Flashcards
Prediabetes
-individuals have blood glucose levels that are higher than normal but below diagnostic levels
-prediabetes is a condition that precedes type 2 diabetes
-prediabetes is also called impaired glucose tolerance (IGT: 7.8-11.0mmol/L) and impaired fasting glucose (IFG: 6.1-6.9mmol/L)
People with prediabetes are at high risk for developing
Diabetes and CVD
Prediabetes is associated with
Abdominal obesity, high triglycerides and or low high density lipoprotein (HDL) cholesterol and hypertension
Does prediabetes have symptoms?
No
Diabetes mellitus
Group of disorders characterized by hyperglycaemia resulting from defective insulin secretion, defective insulin action or a combination of both
Diabetes mellitus
Group of disorders characterized by hyperglycaemia resulting from defective insulin secretion, defective insulin action or a combination of both
-hyperglycaemia is abnormally increased blood glucose
4 major clinical types of diabetes
- Type 1: insulin deficient
- Type 2: insulin resistant
- Gestational
- Other specific types
Tyoe 1 diabetes
-commonly occurs in childhood and adolescence but can strike at any age
-the body does not produce insulin
-these individuals are rarely obese, and to survive they require administration of insulin by injection or pump
Type 2 diabetes
Most common form
-results form insulin resistance and is preventable
-most individuals with type 2 are obese and or have an increased percentage of body fat distributed in the abdominal region
Gestational diabetes mellitus
-occurs during pregnancy
-clinical characteristics include glucose intolerance that has its onset or recognition during pregnancy
-high risk women include those with marked obesity, previous GDM, a strong family history of diabetes and glucose intolerance the urine
-increases risk of perinatal morbidity and mortality. Maternal complications include increased rate of cesarean delivery and chronic hypertension
Other specific types of diabetes
-DM associated with certain conditions and syndromes
-heterogenous in nature and includes diabetes in which the causative relationship is known
-these forms may occur at any stage of life and be acquired environmentally, iartogenically, as a result of a genetic mutation that predisposes to type 1 or type 2 or a combined form of diabetes or in other metabolic disorders where hyperglycaemia is more likely to develop
Pathophysiology of diabetes
-to use glucose the body must produce insulin. A person with diabetes produces too little insulin or has an inability to use insulin
- insulin an anabolic hormone stimulates the entry of glucose into cells and enhances fat storage. Without insulin glucose remains in the bloodstream rather than being stored or used by cells to produce energy
What are produced as a result of catabolism of fatty acids or lipolysis
Ketoacids and ketone bodies
-ketones accumulate in the tissues, are excreted in the urine (ketonuria), and circulate in the blood (ketonemia), causing a drop in the pH of the blood and leading to seizures and diabetic coma
Ketoacidosis
Blood glucose levels rise to >400mg/dL
Cardinal signs of diabetes include
Polydipsia: excessive thirst
Polyuria: excessive urination
Polyphagia: excessive ingestion of food
Unexplained weight loss
Weakness
6 chronic complications due to Hyperglycaemia include
-micro vascular and macro vascular disease
-diabetic retinopathy with potential vision loss
-nephropathy leading to renal failure
-peripheral neuropathy with risk of foot ulcers, amputation, and neuropathic joint disease
-autonomic neuropathy causing GI, genitourinary and cardiovascular symptoms and sexual dysfunction
-periodontal disease
Hypoglycaemia symptoms
Hunger
Irritability
Trouble concentrating
Fatigue
Sweating
Confusion
Fast heartbeat
Shaking
Headache
Hyperglycaemia symptoms
Extreme thirst
Dry mouth
Weakness
Headache
Frequent urination
Blurry vision
Nausea
Confusion
Shortness of breath
The most important aspect in the control of diabetes mellitus is
Self monitoring of blood glucose
-the frequency of monitoring is highly individualized
Glycemic control
Self monitoring of blood glucose and A1c
-A1c test measures what % of your hemoglobin is coated with sugar (glycated). The higher your A1c level, the poorer your blood sugar control and the higher your risk of diabetes complications NORMAL A1c level is below 5.7%
-this test is used as a record of blood glucose levels over the past 3 months
Disease management: oral hypoglycemic agents
Generally stimulate pancreas to secrete more insulin, increase the body’s response to insulin, slow glucose digestion or decrease glucose production by the liver
-metformin
-sulfonylureas
-meglitinides
-thiazolidienodione
-dipeptidyl peptidase-5 inhibitors
-alpha glucosidase inhibitors
Disease management: injectable agents for type 2
Exenatide(Byetta)
Amylinomimetics (pramlintide [Symlin])
Many people with diabetes are also treated with
Anticoagulant/antiplatelet drugs, antihypertensive drugs, or lipid lowering medications
DH process of care
-infections of any type can cause a profound disturbance of glycemic control
-prevention of oral disease and infections is critical to the pts diabetic control, and pore diabetic control may aggravate the oral disease status
-several unmet human needs relate to DH care for individuals with diabetes: for example emotional stress induced by dental spot causes the release of epinephrine which mobilizes glucose from glycogen stored in the liver
Oral assessment
-cheilosis
-Xerostomia
-increased levels of cariogenic MOs
-glossodynia (burning mouth)
-enlarged salivary glands
-increased glucose in saliva
-fungal infections such as candidiasis
-dental caries
-perio
Hyperglycaemia progressively leads to an increase of proinflammatory cytokines such as
Tumor necrosis factor-alpha, interleukin 6, and others that destroy connective tissue and bone
For children and adolescents diagnosed with diabetes an annual oral exam for early signs of periodontal involvement is recommended starting at the age of
6
What are contraindicated for people with uncontrolled diabetes
Therapeutic scaling and periodontal debridement
A person with well controlled diabetes and no evidence of infection does not require
Prophylactic antibiotic premedication.
Why should vasoconstrictors in LA be used with caution?
Epinephrine is capable of raising blood glucose
Individuals with uncontrolled diabetes increase their risk of a medical emergency like
Coma
Hypoglycaemia
Ketoacidotic hyperglycaemia
Nonketotic hyperosmolar hyperglycaemia
-lactic acidosis
-uremia
-non diabetic coma
-infection
-myocardial infarction
-stroke
-emergency surgery
What is the most common metabolic emergency in persons with type 1 diabetes
Hypoglycaemia
Coma that results from absolute insulin deficiency is found in persons with
Acute onset type 1 diabetes in whom diagnosis was unknown or delayed and in individuals with known diabetes who discontinued or decreased their insulin dose for some reason
