Diabetes Management in Dental Setting Flashcards
T/F: 1 in 4 don’t know that they are diabetic
true
T/F: 1 in 3 Americans are pre-diabetic
true
T/F: 90% of people with pre-diabetes don’t know it
true
considered pre-diabetic if impaired fasting plasma glucose
> 100 mg/dL
< 125 mg/dL
considered pre-diabetic if impaired oral glucose tolerance
140 mg/dL - 199 mg/dL
considered pre-diabetic if hemoglobin A1c is what?
5.7-6.4%
what must you assume about your patients?
- > 30% of pts may display baseline dysglycemia
- hyperglycemia may be induced by surgical stress
- many of your dental patients will be in diabetic or pre-diabetic state
diabetes mellitus is an inability to properly metabolize what?
- carbohydrates
- proteins
- lipids
what causes diabetes mellitus?
- complete lack of insulin production (type 1)
- an inadequate amount of insulin secretion by pancreatic beta cells
- tissue insensitivity to insulin (i.e. obesity)
- insulin that is ineffective or destroyed before it reaches its target site
what has to happen in order for glucose to enter a cell?
- insulin binds to alpha chains on cell membrane
- beta chains are phosphorylated
- intracellular tyrosine kinase is activated
- insulin receptor substrates are activated
- synthesis of various substances (including glucose transport protein)
- glucose transport proteins bind to cell membrane
when normal transport of glucose is inhibited, what happens?
blood glucose levels rise
what blood glucose level is considered hypoglycemia?
55-75 mg/dL
what blood glucose level is considered normal?
75-100 mg/dL
what blood glucose level is considered hyperglycemia?
> 100 mg/dL
what HbA1c level is considered normal glycated hemoglobin?
4.0-5.6%
what HbA1c level is considered pre-diabetes?
5.7-6.4%
what HbA1c level is considered diabetes?
> 6.5%
what HbA1c level is considered “controlled” diabetes?
<7.0%
what percent of diabetes mellitus type 2 patients have NO comorbid conditions?
14%
most common comorbidities for diabetic patients
- obesity
- cardiovascular disease
- hypertension
- dyslipidemia
- kidney disease
what is the most common cause of mortality in diabetic patients?
cardiovascular disease
diabetic patients with cardiovascular disease poorly tolerates what?
tachycardia
10x increase in death if HR >105 for longer than 5 min in post-op period
what percent of DM2 pts are overweight or obese?
90%
diabetic pts who are also obese have a higher incidence of what?
- obstructive sleep apnea
- GERD
- airway management issues (ventilation and oxygenation)
what percent of DM2 pts have HTN?
70%
ADA recommends keeping BP at what level for diabetic pts with HTN?
<140/80 mmHg
what has a greater effect on morbidity and mortality than glycemic control in diabetic pts?
HTN
what percent of DM2 pts have chronic kidney disease?
40%
insulin dependent diabetics with chronic kidney disease are at risk for what?
HYPOglycemia
what can’t DM2 pts with chronic kidney disease take?
many oral anti-diabetic meds like metformin
T/F: study showed increased mortality in drastic reduction in hyperglycemic levels of DM2 pts
true, slowly decrease pt’s HbA1c
Society for ambulatory anesthesia (SAMBA) recommends what blood glucose level?
<180 mg/dL
what are the risks of intra-operative hyperglycemia
- dehydration
- ketoacidosis
- hyperosmolar hyperglcemic state
- delayed wound healing
- wound infection
how often should blood glucose level be checked on diabetic pt?
- beginning of appt
- after 2 hrs
- every hour thereafter
- at the end of the appt
how does a diabetic get HYPOglycemia?
- taking diabetic meds
- skipping breakfast
- long dental appts
- inability to eat after surgery
signs and symptoms of hypoglycemia
- behavioral changes (confusion, combativeness)
- weakness
- fatigue
- sweating
- palpitations
differential diagnosis of hypoglycemia
- cerebral ischemia
- myocardial infarction
- dementia
- drug overdose
- drug under dose
when do signs of hypoglycemia manifest?
at blood glucose of 45-55 mg/dL
at what blood glucose level should you consider treating hypoglycemia?
at 70 mg/dL
tx of hypoglycemic pt with blood glucose level of <70 mg/dL
15 grams of fast-acting carbs
tx of hypoglycemic pt with blood glucose level of <50 mg/dL
30 grams of fast-acting carbs
foods that contain ~15g of fast-acting carbohydrates
- 1/2 cup apple juice
- 1/2 cup non diet soda
- 1 small apple or orange
- 6 hard candies
- 1 tbsp jam/jelly
3-4-5 rule
1 gram of ingested glucose will raise blood surgar 4 mg/dL
if pt’s weighs 100 lbs, 1 gram of ingested glucose will raise the pt’s blood sugar by how much?
5 mg/dL
if pt’s weighs 150 lbs, 1 gram of ingested glucose will raise the pt’s blood sugar by how much?
4 mg/dL
if pt’s weighs 200 lbs, 1 gram of ingested glucose will raise the pt’s blood sugar by how much?
3 mg/dL
how much dextrose should be given to unconscious hypoglycemic pt if IV is present?
50 mL of dextrose 50% (D50) = 25 grams dextrose
50 mL of dextrose 50% (D50) = 25 grams dextrose intravenously will raise the pt’s blood glucose level by how much?
75-125 mg/dL
what should be given to an unconscious hypoglycemic pt if an IV is not present?
1 unit glucagon given subcutaneously
signs and symptoms of HYPERglycemia
- fatigue
- vision disturbances
- nausea
- excessive thirst
- polyuria
how many units should you give a hyperglycemic patient who doesn’t take insulin?
assume 60 units
1800 rule
divide pt’s daily insulin requirement into 1800
1 unit of rapid acting insulin (given subcutaneously) will drop the blood glucose that many points
example of common rapid-acting insulin
lispro (humalog)
