Diabetes (Desai) Flashcards by Matthew Stringham

What are 4 dental problems with increased incidence in diabetic patients?

Gingivitis
Periodontal disease
Oral infection
Dental caries

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What are 3 late complications associated with Diabetes Mellitus?

Retinopathy
Nephropathy
Neuropathy

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What percentage of population over age 65 is affected by diabetes?

10%

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What percent of the general population is affected by diabetes?

2-4%

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Diabetes is the leading cause of what 2 things in adults?

Blindness

2. End stage renal disease

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What diabetes mellitus type represents 10-15% of all diabetics in the US, and was formerly called Insulin-dependent or juvenile diabetes with onset usually below age of 30, with abrupt onset and weight loss?

Type I

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Type I diabetics are absolutely dependent on what?

Insulin

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What diabetes mellitus type representing 85-90% of all diabetics in the US, formerly adult onset or non-insulin dependent diabetes, on set is usually insidious and usually obese with a strong genetic component?

Type II

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What 2 factors affect Type II diabetes mellitus?

Pancreas does not produce enough insulin to maintain normal glucose levels.
Patient is resistant to insulin action

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Is an impaired glucose tolerance test (IGT) with higher than normal glucose levels diagnostic of diabetes? What are patient’s with a high IGT at increased risk for?

NOT diagnostic of diabetes. Patients with high IGT are at increased risk of atherosclerotic complications.

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What are the 3 P’s of diabetes?

Polyuria
Polydypsia
Polyphagia

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What is the clinical presentation that is particular to type I diabetes?

Ketoacidosis

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What causal plasma glucose level is diagnostic for diabetes?

> 200 mg/dl + symptoms of diabetes

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What fasting plasma glucose value is diagnostic for diabetes?

> 126 mg/dl

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What 2-hour plasma glucose level during an oral glucose tolerance test is diagnostic for diabetes?

> 200 mg/dl

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What is a normal fasting plasma glucose level?

<100mg/dl

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What is an impaired fasting glucose range?

> 100 and <126 mg/dl

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What is an impaired glucose tolerance (IGT) 2 hour post glucose load?

> 140 and <200 mg/dl

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What are 3 acute complications for diabetes?

Ketoacidosis
Hypoglycemic
Hyperosmolar

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Diabetic patient that has 3 P’s (polyuria, polydypsia, polyphagia), dehydration, rapid deep respirations, abdominal pain, nausea and vomiting is having what high mortality rate acute diabetic complication?

Diabetic ketoacidosis

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Diabetic ketoacidosis usually develops in what diabetic type patient?

Type I

What is a diabetic acute complication that usually occurs in insulin-treated patients, but may occur in patients on oral agents usually from skipping meals, vigorous exercise, or an error in insulin dosage?

Hypoglycemia

Can you treat a person that is hypoglycemic?

Yes, treat the hypoglycemia and refer to the ER. If alert give oral glucose

What are 3 chronic complications of diabetes?

Vascular (Macro or Micro)
Neuropathy
Mixed vascular/neuropathic

What are 3 macrovascular complications of diabetes?

1. Coronary Artery Disease (heart attacks, angina) 2. Cerebrovascular Disease (strokes, TIA’s) 3. Peripheral Vascular Disease (gangrene, amputations)

What are 2 microvascular complications of diabetes?

1. Retinopathy (visual impairment) | 2. Nephropathy (end stage renal disease)

Even though tight control of Type I diabetes has shown a decrease in retinopathy, nephropathy, and neuropathy, what is significantly increased?

Hypoglycemia (3x the risk)

What are 6 goals of diabetic therapy?

1. Blood sugars in normal range 2. Avoid hypoglycemia 3. Achieve/maintain ideal body weight 4. Maintain normal growth and development in kids 5. Allow patients to live a normal life 6. Prevent or postpone chronic complications

What are 3 very short-acting insulins?

1. Humalog (Lispro) 2. Novalog 3. Apidra

What is a short acting insulin?

Regular (I don't even know what this answer even means)

What are 2 new anti-diabetic agents, one a GLP-1 analogue and one a DPP4 inhibitor?

1. Exenatide (Byetta) | 2. Sitagliptin (Januvia)

What is indicated for a previously undiagnosed diabetic patient?

Referral

What is indicated for a previously diagnosed patient with symptoms of poor control, hypoglycemia, or a complication?

Referral

What is required prior to a major dental procedure on a diabetic?

Medical consult

What are 2 absolute indications for referral of a diabetic?

1. Blood sugar >400 mg/dl | 2. Ketones in urine

Is there a specific change in the diabetic routine for a routine dental procedure that does not require decreased caloric intake by the patient?

No change required

Patients with a complication from a dental procedure, especially infection, should receive what?

Prompt, aggressive treatment for both the infection and diabetes

Infections are a common precipitating event for what in diabetics?

Ketoacidosis

If a patient requires a major dental procedure requiring general anesthesia or NPO prior, what is required?

Medical consult

If a diabetic patient that was previously controlled by diet or oral agents must have a major dental procedure requiring general anesthesia or NPO, what may be required?

Transient insulin in perioperative period

If an insulin-requiring patient must have a major dental procedure requiring general anesthesia or NPO, what may be required?

Significant alteration in usual regimen

In post-op period, should glucose control be tight in the diabetic and what is the key to avoid?

Adequate control but not tight. Avoid hypoglycemia.

Is prophylactic antibiotic coverage indicated for a diabetic?

Not generally. If brittle diabetic with invasive procedure whose fasting plasma glucose exceeds 200mg/dl

What instructions should you give a diabetic on the day of an appointment?

Take usual insulin dose and eat as normal. Confirmat the appointment that this has been followed

What is a good HbA1c?

6 and below

What is the high limit for glucose in a diabetic?

400 mg/dL

What is the low limit in blood glucose in a diabetic?

80mg/dL

According to Dr Cane, what are 3 reasons why you would call EMS to your dental office?

1. Need equipment you don't have 2. Need to transport the patient to a higher level of care 3. Need a body bag

What happens if you have a diabetic patient who undergoes a seizure in your dental office?

1. Get glucose up | 2. Give valium or versed to stop seizure

What are some acute side effects of type I diabetic?

1. Hyperglycemia | 2. Diabetic ketoacidosis

What is the term for a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure?

Kussmaul breathing