Diabetes

Question 1

What is Diabetes

Answer 1

Metabolic disorder characterized by hyperglycemia due to inability to produce/use insulin

Question 2

Insulin

Answer 2

• Produced by beta cells in pancreas
• regulates metabolism of carbohydrates, fats, protein
• promotes absorption of glucose from the blood into liver, fat and skeletal muscle cells
• converted into glycogen, fat

Pathophysiology: lack of insulin/deficient action of insulin leads to abnormalities in carbohydrate, fat and protein metabolism. Results in glucose accumulation in tissue fluids and blood.

Question 3

Types if Diabetes

Answer 3

Type 1 (5-10%)

beta cell destruction >>> absolute insulin deficiency

genetic / autoimmune / environmental (viruses)

common in children

Type 2

insulin resistance, relative insulin deficiency

Obesity most common cause

Gestational 5% pregnant women

Obesity = risk factor

Return to normal post partum but increased risk of DM later

Greater risk of miscarriage, larger size of fetus

Question 4

Primary manifestation

Answer 4

• hyperglycemia
• ketoacidosis (fruity breath)
• vascular disease
  
  • atherosclerosis (stroke, CVD #1 cause of death)
  • retinopathy #1 cause of blindness,
  • nephropathy #1 cause of renal failure
  • peripheral artery dz (gangrene of extremities)
• neuropathy
• immunocompromised, poor wound healing.

Ketoacidosis: body breaks down fatty acids to ketone for energy because glucose cannot be properly absorbed into cells for utilization. Leads to metabolic imbalance

Question 5

Signs/Symptoms

Answer 5

Type 1: polyuria, polydipsia, polyphagia.

Type 2: slight weight loss/gain, nausea, blurred vision

Question 6

Diagnosis

Answer 6

Question 7

Oral Manifestations

Answer 7

• Periodontal disease accelerated
• Gingival proliferations
• Infection
• Poor wound healing
• Xerostomia
• Oral ulcereations
• Candidiasis, Mucormycosis
• Numbing, burning, pain in oral tissues

Question 8

Pharmacological Management

Answer 8

Type 1: Insulin injection/infusion

Type 2: Oral hypoglycemic agents (metformin, sulfonylureas), Insulin, lifestyle modification

Question 9

Dental Management

Answer 9

Insulin Shock/Hypoglycemic Shock (Fast onset):

• Mild: Hunger, Weakness, Tachycardia, Pallor, Sweating
• Moderate: Incoherent, Uncooperative, belligerent, Poor orientation
• Severe: Unconsciousness, Tonic/Clonic movements, Hypotensive

Hyperglycemic Crisis (Slow onset):

Diabetic Ketoacidosis (DKA) – Insulin insufficiency, Excessive blood glucose, and Dehydration. Cells break down Fatty acids into ketone bodies/keto acids, blood pH drops, and excessive excretion of fluids/glucose.

Symptoms: Confusion, Hunger, Dehydration, “Fruity” smell breathe

Question 10

Endodontic Literature

Answer 10

Fouad and Burleson 2003

PARL + Diabetes: lower success of NSRCT (impaired healing)

and greater flare-ups