Ch 49 Diabetes

Question 1

Prediabetes

Answer 1

-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)

Question 2

People with prediabetes are at high risk for developing

Answer 2

Diabetes and CVD

Question 3

Prediabetes is associated with

Answer 3

Abdominal obesity, high triglycerides and or low high density lipoprotein (HDL) cholesterol and hypertension

Question 4

Does prediabetes have symptoms?

Answer 4

No

Question 5

Diabetes mellitus

Answer 5

Group of disorders characterized by hyperglycaemia resulting from defective insulin secretion, defective insulin action or a combination of both

Question 6

Diabetes mellitus

Answer 6

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

Question 7

4 major clinical types of diabetes

Answer 7

1. Type 1: insulin deficient
2. Type 2: insulin resistant
3. Gestational
4. Other specific types

Question 8

Tyoe 1 diabetes

Answer 8

-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

Question 9

Type 2 diabetes

Answer 9

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

Question 10

Gestational diabetes mellitus

Answer 10

-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

Question 11

Other specific types of diabetes

Answer 11

-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

Question 12

Pathophysiology of diabetes

Answer 12

-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

Question 13

What are produced as a result of catabolism of fatty acids or lipolysis

Answer 13

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

Question 14

Ketoacidosis

Answer 14

Blood glucose levels rise to >400mg/dL

Question 15

Cardinal signs of diabetes include

Answer 15

Polydipsia: excessive thirst
Polyuria: excessive urination
Polyphagia: excessive ingestion of food
Unexplained weight loss
Weakness

Question 16

6 chronic complications due to Hyperglycaemia include

Answer 16

-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

Question 17

Hypoglycaemia symptoms

Answer 17

Hunger
Irritability
Trouble concentrating
Fatigue
Sweating
Confusion
Fast heartbeat
Shaking
Headache

Question 18

Hyperglycaemia symptoms

Answer 18

Extreme thirst
Dry mouth
Weakness
Headache
Frequent urination
Blurry vision
Nausea
Confusion
Shortness of breath

Question 19

The most important aspect in the control of diabetes mellitus is

Answer 19

Self monitoring of blood glucose
-the frequency of monitoring is highly individualized

Question 20

Glycemic control

Answer 20

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

Question 21

Disease management: oral hypoglycemic agents

Answer 21

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

Question 22

Disease management: injectable agents for type 2

Answer 22

Exenatide(Byetta)
Amylinomimetics (pramlintide [Symlin])

Question 23

Many people with diabetes are also treated with

Answer 23

Anticoagulant/antiplatelet drugs, antihypertensive drugs, or lipid lowering medications

Question 24

DH process of care

Answer 24

-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

Question 25

Oral assessment

Answer 25

-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

Question 26

Hyperglycaemia progressively leads to an increase of proinflammatory cytokines such as

Answer 26

Tumor necrosis factor-alpha, interleukin 6, and others that destroy connective tissue and bone

Question 27

For children and adolescents diagnosed with diabetes an annual oral exam for early signs of periodontal involvement is recommended starting at the age of

Answer 27

6

Question 28

What are contraindicated for people with uncontrolled diabetes

Answer 28

Therapeutic scaling and periodontal debridement

Question 29

A person with well controlled diabetes and no evidence of infection does not require

Answer 29

Prophylactic antibiotic premedication.

Question 30

Why should vasoconstrictors in LA be used with caution?

Answer 30

Epinephrine is capable of raising blood glucose

Question 31

Individuals with uncontrolled diabetes increase their risk of a medical emergency like

Answer 31

Coma
Hypoglycaemia
Ketoacidotic hyperglycaemia
Nonketotic hyperosmolar hyperglycaemia
-lactic acidosis
-uremia
-non diabetic coma
-infection
-myocardial infarction
-stroke
-emergency surgery

Question 32

What is the most common metabolic emergency in persons with type 1 diabetes

Answer 32

Hypoglycaemia

Question 33

Coma that results from absolute insulin deficiency is found in persons with

Answer 33

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