Chapter 16 Flashcards
True or False
Type II diabetes often occurs because of obesity, high-fat-low-fiber diets, and a sedentary lifestyle.
True
What is insulin?
The hormone that aids in the conversion of sugar and starches to a form that the body can transport to the cells to utilize for energy.
True or False
Diabetes mellitus is an autoimmune metabolic disorder characterized by hyperglycemia (high blood glucose levels)
True
What are the three types of diabetes mellitus?
Type 1
Type 2
Gestational diabetes
What are the characteristics of Type I diabetes?
Absolute lack of circulating insulin
Patients dependent on supplemental insulin for survival
5-10% of all diabetes
What are the characteristics of Type II diabetes?
Inability of the body to produce sufficient amount of insulin or to properly use the insulin that is produced
Managed by diet, oral medications, or injectable medications
90-95% of all diabetes
What are the characteristics of gestational diabetes?
Occurs in 2-5% of pregnant women
characterized by glucose intolerance, with initial onset during pregnancy
If left untreated can cause significant developmental disturbances to fetus
True or False
A person with a fasting blood glucose level of 126 mg/dL or higher has diabetes
True
What are some systemic complications of diabetes mellitus?
Diabetic retinopathy Macrovascular and microvascular complications Diabetic neuropathy Diabetic nephropathy Oral complications
What is diabetic retinopathy?
Disease of the retina of the eye resulting from changes in the blood vessels
Leading cause of blindness in individuals age 20-74
What are macrovascular and microvascular complications?
Microangiopathic changes in the capillaries, leading to formation of thrombi and impairment of normal blood flow
Can lead to cerebrovascular accident or myocardial infarction
What is diabetic neuropathy?
Impaired sensation in hands or feet, slowed digestion, carpel tunnel syndrome, other neurological problems
What is diabetic nephropathy?
Damage to the small blood vessels in the kidneys, leading to impairment in function
What are oral complications?
Increased incidence of periodontal disease, abscesses, xerostomia, lichen plans, candidiasis, impaired wound healing
True or False
Once diabetic renal failure has occurred, there is nearly 10% morbidity within 10 years.
True
What is a good way to avoid oral manifestations?
Maintaining optimal glucose levels
What is a normal blood glucose reading?
Between 50 and 150 mG/dL
Reading below 50: hypoglycemic
Reading above 150: hyperglycemic
What is the glycated hemoglobin test (HbA1c)?
Test reveals the patient’s “average” blood sugar level over the past two to three months
What is the medication recommended for use of patients with type I diabetes?
Insulin (Humalog or Novolog)
What are some medications recommended for the use of patients with type II diabetes?
Metformin (Glucophage)
Tolbutamide (Orinase)
Glyburide (Micronase, Diabeta, Glynase)
True or False
Pancreas or pancreatic islet cell transplantation is another option for some diabetic patients to aid in controlling blood glucose levels.
True
What are some strategies that can be used by the dental professional when treating a diabetic patient?
Scheduling appointments in the early to mid-morning hours
Keeping appointments short
Instructing the patient to continue normal dietary intake before appointment
Checking patient’s blood glucose prior to any invasive procedure
Using topical fluoride when patients are at risk for caries
Recommending saliva substitutes for xerostomia
What are the three medical emergencies in which a diabetic patient may suffer in the dental office?
Severe hyperglycemia (diabetic ketoacidosis)
Hyperosmolar hyperglycemic state
Hypoglycemia
True or False
25% of all cases of DKA (diabetic ketoacidosis) occur in newly presenting type I diabetes
True
What is diabetic ketoacidosis?
caused by insufficient insulin levels in the blood, which causes the body to shift towards metabolizing fatty acids for energy, causing blood to become more acidic than usual
What are some signs and symptoms of DKA?
Tachypnea accompanied by an increased depth in respirations Alteration in mental status (drowsiness to coma) Dehydration Poor skin turgor Warm dry skin and mucous membranes Increased thirst Muscle weakness Severe fatigue Nausea Vomiting Blurred vision Fruity odor on breath Hypotension Tachycardia
True or False
In children, a common complication of DKA is cerebral edema which has a high mortality and morbidity rate; therefore, appropriate and swift treatment of the condition is essential.
True
What are some steps in the treatment of DKA?
Determine accurate blood glucose level (using glucometer)
Fluid therapy
Insulin (done by medical professional)
Monitor vital signs
What is hyperosmolar hyperglycemic state?
Patients will be hyperglycemic and dehydrated
Occurs in elderly, neglected, institutionalized, or mentally challenge
Cannot recognize their own thirst or express their need for water
What are some signs and symptoms of hypoglycemia?
Confusion Seizures Coma Dizziness Weakness Syncope Headache Intense hunger Cold, clammy skin Profuse perspiration Irritability or aggressive behavior
True or False
Hypoglycemia occurs when a blood glucose level is lower than 40-50 mg/dL
True
What is the treatment for a patient suffering from hypoglycemia?
15-20 gm of some form of sugar (table sugar, honey, candy, orange juice, glucose tablets)
Vital signs monitored
Unconscious: glucagon
An absolute lack of circulating insulin is characteristic of which condition?
Type I diabetes
A result of 115 mg/dL on a fasting plasma glucose test would indicate
Prediabetes
What causes the gangrene that is often associated with diabetic patients?
Microangiopathic changes
All of the following are oral complications associated with diabetes except one. Which one is the exception?
Squamous cell carcinoma
Which diabetic emergency is associated with the following symptoms: tachypnea, Kussmaul’s breathing, nausea, blurred vision, fruity odor on the breath?
Diabetic ketoacidosis
What is the needed treatment for the emergency in the condition cited in question 5?
Administration of insulin
The test used to measure a diabetic’s average glucose level over the past three months is
HbA1c test
All of the following are symptoms of hypoglycemia in a diabetic patient except one. Which is the exception?
Cyanosis
What is the diabetic emergency that is often seen in institutionalized individuals?
Hyperosmolar hyperglycemic state
All of the following are medications often prescribed for type 2 diabetes except one. Which one is the exception?
Glucagon
