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Pharm 2 final > Diabetes Management in Dental Setting > Flashcards

Diabetes Management in Dental Setting Flashcards

1
Q

T/F: 1 in 4 don’t know that they are diabetic

A

true

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2
Q

T/F: 1 in 3 Americans are pre-diabetic

A

true

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3
Q

T/F: 90% of people with pre-diabetes don’t know it

A

true

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4
Q

considered pre-diabetic if impaired fasting plasma glucose

A

> 100 mg/dL

< 125 mg/dL

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5
Q

considered pre-diabetic if impaired oral glucose tolerance

A

140 mg/dL - 199 mg/dL

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6
Q

considered pre-diabetic if hemoglobin A1c is what?

A

5.7-6.4%

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7
Q

what must you assume about your patients?

A
  1. > 30% of pts may display baseline dysglycemia
  2. hyperglycemia may be induced by surgical stress
  3. many of your dental patients will be in diabetic or pre-diabetic state
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8
Q

diabetes mellitus is an inability to properly metabolize what?

A
  1. carbohydrates
  2. proteins
  3. lipids
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9
Q

what causes diabetes mellitus?

A
  1. complete lack of insulin production (type 1)
  2. an inadequate amount of insulin secretion by pancreatic beta cells
  3. tissue insensitivity to insulin (i.e. obesity)
  4. insulin that is ineffective or destroyed before it reaches its target site
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10
Q

what has to happen in order for glucose to enter a cell?

A
  1. insulin binds to alpha chains on cell membrane
  2. beta chains are phosphorylated
  3. intracellular tyrosine kinase is activated
  4. insulin receptor substrates are activated
  5. synthesis of various substances (including glucose transport protein)
  6. glucose transport proteins bind to cell membrane
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11
Q

when normal transport of glucose is inhibited, what happens?

A

blood glucose levels rise

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12
Q

what blood glucose level is considered hypoglycemia?

A

55-75 mg/dL

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13
Q

what blood glucose level is considered normal?

A

75-100 mg/dL

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14
Q

what blood glucose level is considered hyperglycemia?

A

> 100 mg/dL

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15
Q

what HbA1c level is considered normal glycated hemoglobin?

A

4.0-5.6%

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16
Q

what HbA1c level is considered pre-diabetes?

A

5.7-6.4%

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17
Q

what HbA1c level is considered diabetes?

A

> 6.5%

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18
Q

what HbA1c level is considered “controlled” diabetes?

A

<7.0%

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19
Q

what percent of diabetes mellitus type 2 patients have NO comorbid conditions?

A

14%

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20
Q

most common comorbidities for diabetic patients

A
  1. obesity
  2. cardiovascular disease
  3. hypertension
  4. dyslipidemia
  5. kidney disease
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21
Q

what is the most common cause of mortality in diabetic patients?

A

cardiovascular disease

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22
Q

diabetic patients with cardiovascular disease poorly tolerates what?

A

tachycardia

10x increase in death if HR >105 for longer than 5 min in post-op period

23
Q

what percent of DM2 pts are overweight or obese?

A

90%

24
Q

diabetic pts who are also obese have a higher incidence of what?

A
  1. obstructive sleep apnea
  2. GERD
  3. airway management issues (ventilation and oxygenation)
25
Q

what percent of DM2 pts have HTN?

A

70%

26
Q

ADA recommends keeping BP at what level for diabetic pts with HTN?

A

<140/80 mmHg

27
Q

what has a greater effect on morbidity and mortality than glycemic control in diabetic pts?

A

HTN

28
Q

what percent of DM2 pts have chronic kidney disease?

A

40%

29
Q

insulin dependent diabetics with chronic kidney disease are at risk for what?

A

HYPOglycemia

30
Q

what can’t DM2 pts with chronic kidney disease take?

A

many oral anti-diabetic meds like metformin

31
Q

T/F: study showed increased mortality in drastic reduction in hyperglycemic levels of DM2 pts

A

true, slowly decrease pt’s HbA1c

32
Q

Society for ambulatory anesthesia (SAMBA) recommends what blood glucose level?

A

<180 mg/dL

33
Q

what are the risks of intra-operative hyperglycemia

A
  1. dehydration
  2. ketoacidosis
  3. hyperosmolar hyperglcemic state
  4. delayed wound healing
  5. wound infection
34
Q

how often should blood glucose level be checked on diabetic pt?

A
  1. beginning of appt
  2. after 2 hrs
  3. every hour thereafter
  4. at the end of the appt
35
Q

how does a diabetic get HYPOglycemia?

A
  1. taking diabetic meds
  2. skipping breakfast
  3. long dental appts
  4. inability to eat after surgery
36
Q

signs and symptoms of hypoglycemia

A
  1. behavioral changes (confusion, combativeness)
  2. weakness
  3. fatigue
  4. sweating
  5. palpitations
37
Q

differential diagnosis of hypoglycemia

A
  1. cerebral ischemia
  2. myocardial infarction
  3. dementia
  4. drug overdose
  5. drug under dose
38
Q

when do signs of hypoglycemia manifest?

A

at blood glucose of 45-55 mg/dL

39
Q

at what blood glucose level should you consider treating hypoglycemia?

A

at 70 mg/dL

40
Q

tx of hypoglycemic pt with blood glucose level of <70 mg/dL

A

15 grams of fast-acting carbs

41
Q

tx of hypoglycemic pt with blood glucose level of <50 mg/dL

A

30 grams of fast-acting carbs

42
Q

foods that contain ~15g of fast-acting carbohydrates

A
  1. 1/2 cup apple juice
  2. 1/2 cup non diet soda
  3. 1 small apple or orange
  4. 6 hard candies
  5. 1 tbsp jam/jelly
43
Q

3-4-5 rule

A

1 gram of ingested glucose will raise blood surgar 4 mg/dL

44
Q

if pt’s weighs 100 lbs, 1 gram of ingested glucose will raise the pt’s blood sugar by how much?

A

5 mg/dL

45
Q

if pt’s weighs 150 lbs, 1 gram of ingested glucose will raise the pt’s blood sugar by how much?

A

4 mg/dL

46
Q

if pt’s weighs 200 lbs, 1 gram of ingested glucose will raise the pt’s blood sugar by how much?

A

3 mg/dL

47
Q

how much dextrose should be given to unconscious hypoglycemic pt if IV is present?

A

50 mL of dextrose 50% (D50) = 25 grams dextrose

48
Q

50 mL of dextrose 50% (D50) = 25 grams dextrose intravenously will raise the pt’s blood glucose level by how much?

A

75-125 mg/dL

49
Q

what should be given to an unconscious hypoglycemic pt if an IV is not present?

A

1 unit glucagon given subcutaneously

50
Q

signs and symptoms of HYPERglycemia

A
  1. fatigue
  2. vision disturbances
  3. nausea
  4. excessive thirst
  5. polyuria
51
Q

how many units should you give a hyperglycemic patient who doesn’t take insulin?

A

assume 60 units

52
Q

1800 rule

A

divide pt’s daily insulin requirement into 1800

1 unit of rapid acting insulin (given subcutaneously) will drop the blood glucose that many points

53
Q

example of common rapid-acting insulin

A

lispro (humalog)

Pharm 2 final (10 decks)

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