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xD3 Med Mgmt Ex1 > Diabetes (Desai) > Flashcards

Diabetes (Desai) Flashcards

0
Q

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

A
  1. Gingivitis
  2. Periodontal disease
  3. Oral infection
  4. Dental caries
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1
Q

What are 3 late complications associated with Diabetes Mellitus?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
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2
Q

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

A

10%

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3
Q

What percent of the general population is affected by diabetes?

A

2-4%

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4
Q

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

A
  1. Blindness

2. End stage renal disease

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5
Q

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?

A

Type I

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6
Q

Type I diabetics are absolutely dependent on what?

A

Insulin

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7
Q

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?

A

Type II

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8
Q

What 2 factors affect Type II diabetes mellitus?

A
  1. Pancreas does not produce enough insulin to maintain normal glucose levels.
  2. Patient is resistant to insulin action
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9
Q

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?

A

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

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10
Q

What are the 3 P’s of diabetes?

A
  1. Polyuria
  2. Polydypsia
  3. Polyphagia
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11
Q

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

A

Ketoacidosis

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12
Q

What causal plasma glucose level is diagnostic for diabetes?

A

> 200 mg/dl + symptoms of diabetes

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13
Q

What fasting plasma glucose value is diagnostic for diabetes?

A

> 126 mg/dl

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14
Q

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

A

> 200 mg/dl

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15
Q

What is a normal fasting plasma glucose level?

A

<100mg/dl

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16
Q

What is an impaired fasting glucose range?

A

> 100 and <126 mg/dl

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17
Q

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

A

> 140 and <200 mg/dl

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18
Q

What are 3 acute complications for diabetes?

A
  1. Ketoacidosis
  2. Hypoglycemic
  3. Hyperosmolar
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19
Q

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?

A

Diabetic ketoacidosis

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20
Q

Diabetic ketoacidosis usually develops in what diabetic type patient?

A

Type I

21
Q

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?

A

Hypoglycemia

22
Q

Can you treat a person that is hypoglycemic?

A

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

23
Q

What are 3 chronic complications of diabetes?

A
  1. Vascular (Macro or Micro)
  2. Neuropathy
  3. Mixed vascular/neuropathic
24
Q

What are 3 macrovascular complications of diabetes?

A
  1. Coronary Artery Disease (heart attacks, angina)
  2. Cerebrovascular Disease (strokes, TIA’s)
  3. Peripheral Vascular Disease (gangrene, amputations)
25
Q

What are 2 microvascular complications of diabetes?

A
  1. Retinopathy (visual impairment)

2. Nephropathy (end stage renal disease)

26
Q

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

A

Hypoglycemia (3x the risk)

27
Q

What are 6 goals of diabetic therapy?

A
  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
28
Q

What are 3 very short-acting insulins?

A
  1. Humalog (Lispro)
  2. Novalog
  3. Apidra
29
Q

What is a short acting insulin?

A

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

30
Q

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

A
  1. Exenatide (Byetta)

2. Sitagliptin (Januvia)

31
Q

What is indicated for a previously undiagnosed diabetic patient?

A

Referral

32
Q

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

A

Referral

33
Q

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

A

Medical consult

34
Q

What are 2 absolute indications for referral of a diabetic?

A
  1. Blood sugar >400 mg/dl

2. Ketones in urine

35
Q

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

A

No change required

36
Q

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

A

Prompt, aggressive treatment for both the infection and diabetes

37
Q

Infections are a common precipitating event for what in diabetics?

A

Ketoacidosis

38
Q

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

A

Medical consult

39
Q

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?

A

Transient insulin in perioperative period

40
Q

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

A

Significant alteration in usual regimen

41
Q

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

A

Adequate control but not tight. Avoid hypoglycemia.

42
Q

Is prophylactic antibiotic coverage indicated for a diabetic?

A

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

43
Q

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

A

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

44
Q

What is a good HbA1c?

A

6 and below

45
Q

What is the high limit for glucose in a diabetic?

A

400 mg/dL

46
Q

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

A

80mg/dL

47
Q

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

A
  1. Need equipment you don’t have
  2. Need to transport the patient to a higher level of care
  3. Need a body bag
48
Q

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

A
  1. Get glucose up

2. Give valium or versed to stop seizure

49
Q

What are some acute side effects of type I diabetic?

A
  1. Hyperglycemia

2. Diabetic ketoacidosis

50
Q

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?

A

Kussmaul breathing

xD3 Med Mgmt Ex1 (6 decks)

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