Chapter 69- Diabetes Mellitus Flashcards
Dental professionals have a responsibility to what?
- Recognize signs and symptoms of diabetes for early diagnosis
-Asses and control diabetes to determine the impact on treatment and oral health of p.t.
-Provide preventive oral care and prevent infections and emergencies
-understand infection
treat and identify acute emergencies
A groups of metabolic diseases associated with hyperglycemia
diabetes mellitus
What does hyperglycemia result from?
an insulin deficiency, resistance to insulin action, or both
People with poorly controlled diabetes are at risk of what complications?
-blindness
-kidney failure
-heart disease
-stroke
amputation of toes, feet, legs
How many people in the united states have diabetes?
29 million
How many cases of diabetes is undiagnosed?
1 in 4 ppl
How many cases in the united states have pre diabetes?
1 and 3 adults
Death risks are _______% higher for those with diabetes compared to those without
50
How is diabetes and periodontal disease related?
the inflammatory process involving the pathogenesis of both disease
Patients with diabetes are how much of a greater risk for more severe periodontal disease than those without?
2-4 times
patients with diabetes have more severe what?
periodontal disease and A1c
nonsurgical perio therapy and management of perio has resulted in what?
an average decrease of A1c of 0.6%.
Is well-controlled diabetes a contraindication to a placement of a implant?
nope
a hormone produced in the pancreas. It directly or indirectly affects every organ in the body
insulin
What is responsible for releasing insulin when stimulated by nutrients, primarily glucose?
beta cells in pancreas
What acts like a key to unlock the cell to allow uptake of glucose to use as energy?
insulin
what is the normal glucose levels in a healthy individual?
60-100 ml
normal hemoglobin A1c is less than what
5.7%
results from the destruction of insulin-producing cells in the pancreas
type 1 diabetes
Most prevalent type of diabetes, accounts for 90-95% patients with diabetes
type 2 diabetes
How is type 1 usually identified ?
after acute symptoms of hyperglycemia
screening in asymptomatic adults is recommended for who?
pre diabetes and type 2
What is the former name of type 2 diabetes?
non insulin dependent or adult onset
any degree of glucose intolerance first recognized during pregnancy
gestational diabetes
whats the onset of gestational diabetes?
related to genetics, obesity, and hormones causing insulin resistance
true or false- more than 50% of women with GDM go on to develop type 2 diabetes within 5-10 yrs
true
In gestational diabetes, infants can have these issues:
- larger
- premature birth
- congenital deformaties
- perinatal death
If not treated, this can lead to diabetic coma?
metabolic acidosis
functions of insulin
- facilitates glucose uptake from blood into tissues, which lowers blood glucose level
- speeds the oxidation of glucose within the cells to use for energy
- speeds the conversion of glucose to glycogen to store in liver and skeletal muscles
- facilitates conversion of glucose to fat in adipose tissues
too much insulin
hyperinsullnism
what is the most likely emergency to occur in the dental setting?
hypoglycemia
True or False: Clinician wants to review the medical history well and use follow-up questions to identify risk factors and symptoms of diabetes.
TRUE
What are the 3 Classic symptoms of Diabetes (Known as the 3 P’s)?
- Polyphagia (Excessive Hunger)
- Polydipsia (Excessive Thirst)
- Polyuria (Excessive Urination)
What are the Diagnostic test for Diabetes?
HbA1c or the A1c
What does the A1c do?
Measures the quantity of high glucose bond to a hemoglobin molecule.
What does A1c value do?
Provides an average of blood glucose levels over a 2-3 month period.
The HbA1c test is used to do what?
Diagnose prediabetes and diabetes.
Prediabetes is diagnosed with an A1c value from
5.7 to 6.4%
A1c greater than 6.5% is used to diagnose what?
Diabetes
A1c is also used for what?
to monitor diabetes control
Those with good control of diabetes is recommended tone tested how many times a year?
2
Patients with unstable control of diabetes may need to be tested
Every 3 months
What are the Risk Factors for diabetes?
Adults overweight with a BMI greater than 25 and have other risk factors like:
• Physical inactivity.
• First degree relative with diabetes.
• High risk race/ethnicity such as African American,
• Hispanic, Native American, Asian, Pacific Islander.
• Women who have delivered a baby over 9 pounds or had gestational diabetes during pregnancy.
• Hypertension (>140/90 mm Hg) or taking antihypertensive medications.
• Women with polycystic ovarian syndrome (PCOS).
• History of cardiovascular disease.
• A1c > 5.7%
True or False: Dental visits provide an opportunity to screen patients for undiagnosed diabetes.
TRUE
Individuals who have glucose levels above normal, but do not meet the criteria for dx. of diabetes are considered to have what?
Prediabetes
What does prediabetes mean?
The patient is at risk for developing diabetes
What is suggested to those who are prediabetic?
lifestyle changes such as being more active, reaching health weight and making healthy food choices.
What is the latest medication used to manage the blood glucose levels?
Metformin
What is Medical Nutrition Therapy?
it is individualized for patients to manage and control diabetes.
The ADA recommends nutrition therapy be provided by who?
a registered dietitian/nutritionalist or certified diabetes educator.
All patients with type 1 diabetes require what for survival?
Insulin
Patients with type 2 diabetes may need insulin for what?
Control
What are the different types of insulin?
rapid acting, regular or short acting, intermediate acting, or long acting
Dosage of insulin depends on
The individual
What are the factors that affect the need for insulin?
Food intake, illness, stress, variations in exercise, or infections
What are the methods for insulin administration?
- Subcutaneous injection with syringe.
- Insulin pen
- Continuous subcutaneous insulin infusion with a battery- operated insulin Pump
- Inhalable insulin (Brand name Afrezza).
- Future modes for insulin administration include an insulin patch, and implantable insulin pumps.
What is an Insulin Pump?
a pump that delivers preprogrammed continuous rate of insulin when needed.
It is small cellphone-sized pump that’s worn in a pocket or on a belt or waistband,
How do they treat type 2 diabetes?
Oral medications taken in combination or individually and in conjunction with diet, exercise, and s.t. injection of insulin
True or False: Patients with well-controlled blood glucose levels tend to develop fewer complications later in life than those whose diabetes is less well controlled.
TRUE
Patients with diabetes are more susceptible to what?
infections and impaired healing, which can worsen prognosis.
What can affect glucose levels?
Stress, trauma, and infections
Failure to treat an infection in a diabetic infection can what?
infection intensify the symptoms and increases severity of diabetes; can progress to life- threatening infections/diabetic coma.
The amount of insulin needed can increase with what conditions?
fever, infection, inflammation, trauma, bleeding, pain, or stress.
Diabetics can also have what?
impaired immune response, alterations in metabolism of carbs and protein, vascular changes and impaired circulation, and altered nutritional state.
What can Neuropathy cause?
pain, numbness, or tingling of mouth, face, and extremities.
What are the symptoms of peripheral Neuropathy?
Symptoms vary depending on the sensory nerve fibers affected and may cause loss of sensation in the feet, hands, and fingers.
Neuropathy can make Oral Hygiene difficult due to what?
numbness in the hands/fingers
True or False: As many as 50% of people with peripheral neuropathy may be asymptomatic and not recognize the loss of sensation which can put them at risk for injury and resulting infection.
TRUE
People not recognizing the loss of sensation can lead to infection which can lead to what?
Amputation
What are the Manifestations of Autonomic. Neuropathy?
tachycardia, orthostatic hypotension, gastroparesis, and hypoglycemic unawareness.
Nephropathy is known as what?
Kidney disease
What is a leading cause of renal disease, and the most common cause of end-stage renal disease in the U.S. Dialysis or kidney transplant is needed?
Diabetes
Patients diagnosed with diabetes is screened for what?
Protein in urine
What is a leading cause of blindness thru the progression of diabetic retinopathy?
Diabetes
People with diabetes are more likely to have what?
Glaucoma and cataracts
Individuals with diabetes are at high risk for what?
cardiovascular disease
Heart conditions common in people with diabetes include
- Hypertension.
- High total cholesterol
- High triglycerides
- May lead to myocardial infarction and stroke.
- Risk of coronary heart disease.
What is recommended for the prevention of cardiovascular disease in its with diabetes?
Low-dose aspirin
What is to be recorded in notes during appointment?
- Record status of blood glucose control, including most recent HbA1c and other daily monitoring such as fasting blood glucose levels the patient has performed.
- Update current medications and doses.
- Confirm compliance of medication intake and food consumption.
- Record discussion about relationship between oral health status, oral hygiene status, risk factors, and diabetes.
