Diabetes

Question 1

Describe Type 1 diabetes.

Answer 1

Insulin dependent.
Autoimmune destruction of pancreatic B-cells responsible for producing insulin.

Question 2

Describe Type 2 diabetes.

Answer 2

Loss of insulin sensitivity.
Defective or delayed insulin release, secretion and abnormal post-prandial suppression of glucagon.

Question 3

What medication can cause medication-induced diabetes ?

Answer 3

Long term corticosteroid use.

Question 4

What are the signs/symptoms of diabetes ?

Answer 4

Polyuria.
Polydispia.
Lethargy.
Weight loss.
FH of autoimmune conditions.

Question 5

What two blood tests can be used for diagnosis of diabetes ?

Answer 5

Glucose tolerance test.
Fasting blood sugar test.

Question 6

What value of glucose tolerance test indicates diabetes ?

Answer 6

> 7.8mmol.

Question 7

What two blood tests can be used for monitoring diabetic control ?

Answer 7

Random blood sugar test.
HbA1c.

Question 8

What should your random blood sugar test be to indicate good diabetic control ?

Answer 8

<7mmol.

Question 9

What is the normal value for HbA1c ?

Answer 9

<48mmol/mol or <6.5%

Question 10

What does HbA1c measure ?

Answer 10

Glycosylated haemoglobin, measure control in recent weeks.

Question 11

How should Type 1 diabetes be managed ?

Answer 11

Exercise and diet advice.
Insulin regimes.
Blood monitoring.

Question 12

What are the target blood sugar levels on daily blood monitoring ?

Answer 12

6-8mmol/mol.

Question 13

Name two Type 1 diabetic insulin regimes.

Answer 13

Basal bolus.
Split mixed.

Question 14

How is insulin administered ?

Answer 14

subcutaneous injection

Question 15

How should type 2 diabetes be managed ?

Answer 15

Exercise, weight loss, diet and smoking advice.
BP control.
Metformin.

Question 16

What drugs can be used to managed T2 diabetes ?

Answer 16

Metformin.
Sulphonylurea.
DDP-4 inhibitors.
Insulin.

Question 17

What are the dental consequences of diabetes ?

Answer 17

Increased infection risk.
Poor wound healing.
Periodontitis.
Acute hypo/hyperglycaemic attacks.
Food intake disruption due to appointment times.

Question 18

What time in the day should you consider treating diabetic patients ?

Answer 18

Schedule for morning - natural higher endogenous cortisol levels, increase glucose levels in blood.
Avoid coninciding with maximum insulin activity peak.
Avoid when meal could be missed.

Question 19

What are the general complications related to poorly controlled diabetes ? You should be aware of the warning signs of poor diabetic control.

Answer 19

Peripheral neuropathy.
Retinopathy.
Nephropathy.
CVD disease - hypertension, angina.
Immunosuppression.

Question 20

What HbA1c level would you be willing to treat in primary care ?

Answer 20

<7% - any dental procedure is OK in primary care.

Question 21

Your patient has a HbA1c value between 7-12%, would you be willing to treat this patient ?

Answer 21

In an emergency.
If any surgical treatment is required, it should be treated in secondary care setting.

Question 22

Your patient has a HbA1c value >12%, would you be willing to treat this patient ?

Answer 22

No.
All procedures should be postponed until glycemic control is improved.

Question 23

What reasonable adjustments should be made for diabetic patients ?

Answer 23

Offered late morning appointments.
Large font written information leaflets if retinopathy.
Wheelchair bound if neuropathy has lead to amputation.
Encourage good wound healing.
GA complications due to fasting period.