Diabetes Flashcards
Describe Type 1 diabetes.
Insulin dependent.
Autoimmune destruction of pancreatic B-cells responsible for producing insulin.
Describe Type 2 diabetes.
Loss of insulin sensitivity.
Defective or delayed insulin release, secretion and abnormal post-prandial suppression of glucagon.
What medication can cause medication-induced diabetes ?
Long term corticosteroid use.
What are the signs/symptoms of diabetes ?
Polyuria.
Polydispia.
Lethargy.
Weight loss.
FH of autoimmune conditions.
What two blood tests can be used for diagnosis of diabetes ?
Glucose tolerance test.
Fasting blood sugar test.
What value of glucose tolerance test indicates diabetes ?
> 7.8mmol.
What two blood tests can be used for monitoring diabetic control ?
Random blood sugar test.
HbA1c.
What should your random blood sugar test be to indicate good diabetic control ?
<7mmol.
What is the normal value for HbA1c ?
<48mmol/mol or <6.5%
What does HbA1c measure ?
Glycosylated haemoglobin, measure control in recent weeks.
How should Type 1 diabetes be managed ?
Exercise and diet advice.
Insulin regimes.
Blood monitoring.
What are the target blood sugar levels on daily blood monitoring ?
6-8mmol/mol.
Name two Type 1 diabetic insulin regimes.
Basal bolus.
Split mixed.
How is insulin administered ?
subcutaneous injection
How should type 2 diabetes be managed ?
Exercise, weight loss, diet and smoking advice.
BP control.
Metformin.
What drugs can be used to managed T2 diabetes ?
Metformin.
Sulphonylurea.
DDP-4 inhibitors.
Insulin.
What are the dental consequences of diabetes ?
Increased infection risk.
Poor wound healing.
Periodontitis.
Acute hypo/hyperglycaemic attacks.
Food intake disruption due to appointment times.
What time in the day should you consider treating diabetic patients ?
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.
What are the general complications related to poorly controlled diabetes ? You should be aware of the warning signs of poor diabetic control.
Peripheral neuropathy.
Retinopathy.
Nephropathy.
CVD disease - hypertension, angina.
Immunosuppression.
What HbA1c level would you be willing to treat in primary care ?
<7% - any dental procedure is OK in primary care.
Your patient has a HbA1c value between 7-12%, would you be willing to treat this patient ?
In an emergency.
If any surgical treatment is required, it should be treated in secondary care setting.
Your patient has a HbA1c value >12%, would you be willing to treat this patient ?
No.
All procedures should be postponed until glycemic control is improved.
What reasonable adjustments should be made for diabetic patients ?
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.
