Diabetes Mellitus

Question 1

Which diabetes is more common?

Answer 1

Type II: insulin resistance secondary to genetic, environmental, and aging factors

(Less common: type 1: insulin deficiency secondary to autoimmune destruction of pancreatic beta cells.)

Question 2

T/F. Diabetes suffer from peripheral nervous system and vascular (macrovascular and microvascular) systemic complications.

Answer 2

True.

Question 3

T/F. The leading cause of death in Type 2 diabetes is End-Stage Renal Disease (ESRD).

Answer 3

False, It’s MI. The leading cause of death in Type 1 diabetes is End-Stage Renal Disease (ESRD).

Question 4

What two ways is plasma glucose levels diagnostic of diabetes?

Answer 4

1. fasting on two occasions ≥126mg/dL

2. random, ≥200mg/dL

Question 5

What is HbA1C?

Answer 5

The amount of sugar attached to hemoglobin. It indicates the level of glycemic level over the last 2-3 months

glycosylated HbA1C = ≥6.5%

Question 6

How often are patients HbA1C levels monitored if controlled and uncontrolled?

Answer 6

controlled - 2x/year

uncontrolled - 4x/year

Question 7

What HbA1C values indicate the following:

1. non-diabetic patients
2. well-controlled diabetics

Answer 7

1. less than 6%

2. less than 7%

Question 8

T/F. Systemic complications increase with increasing A1C.

Answer 8

True, patients less than 7% have 42% fewer systemic complications and 57% fewer
death than those >8%
Goal = STRICT GLYCEMIC CONTROL!!

Question 9

How is diabetes managed?

Answer 9

Modified nutrient intake
Physical activity recommendations
Oral hypoglycemics, insulin injections, or insulin pump
Blood pressure control
Favorable lipid profile
Management of CV, renal, and ocular involvement

Question 10

What type of diabetic patient will be managed by the following:

Injectable insulin-subcutaneous
Combination of long and short-acting agents
Mimic normal basal & meal-time secretion
Multiple dosing throughout day

Answer 10

Type I diabetics

Question 11

What type of diabetic patient will be managed by the following:

Lifestyle modifications
Control risk factors for CV disease
BP & lipid control, ASA for antiplatelet therapy
Drug therapy (1 or more hypoglycemics; +/- injectables)

Answer 11

Type II diabetics

Question 12

External Insulin pumps place a catheter in the ___ wall and gives a constant basal infusion. The patient give themselves a bolus at ___.

Answer 12

abdominal; meals

Question 13

What are some follow-up questions specific for diabetes?

Answer 13

Type
Drugs
Glucose monitoring, last value, is this normal for you?
Frequency of MD visits
Timing and results of last A1C
Frequency of insulin reactions
Systemic complications

Question 14

T/F. Elective care should be done after consultation with a physician with controlled diabetics.

Answer 14

False, controlled diabetics can receive elective care. But, be sure to prevent problems secondary to oral hypoglycemics and insulin and check glucose prior to starting treatment.

Question 15

With what glucose measurement should you defer or give carbs? defer elective treatment?

Answer 15

Less than 70 mg/dl : defer or give carbs

200 mg/dl: defer elective treatment

Question 16

Define insulin reaction? What are the 3 clinical stages?

Answer 16

When there is too much insulin and not enough glucose.

3 clinical stages:
Mild- hunger, weakness, sweating, tachycardia
Moderate- incoherent, uncooperative, belligerent, disorientation
Severe- unconscious, hypotensive, tachycardia

Question 17

When treating insulin reaction, if a patient had mild to moderate symptoms and was given cake icing, when should they start to feel better?

What should be done with a patient experiencing severe symptoms?

Answer 17

mild & moderate; better within 5 minutes

severe: EMS and glucagon injection (SC/IM)

Question 18

What can you do to help prevent insulin shock?

Answer 18

1. Instruct patients to follow normal insulin regimen and eat normally around appointment
2. Morning appointment
3. Confirm that they ate and took insulin
4. Instruct patient to notify you of symptoms during the office visit
5. Source of sugar in the office

Question 19

What are some dental treatment concerns for UNcontrolled diabetics?

Answer 19

infection (aggressive management, strict glycemic control)
poor wound healing (avoid elective perio/oral surgery)
systemic risk (HTN, CAD, renal disease, stroke)

Question 20

T/F. With acute odontogenic infections, infection can lead to loss of diabetic control and loss of diabetic control can lead to aggressive infections.

Answer 20

True.

Question 21

T/F. You should be more concerned about Type 1 diabetics on high insulin dosages instead of uncontrolled, and brittle diabetics.

Answer 21

False, You should be more concerned about uncontrolled, and brittle diabetics instead of Type 1 diabetics on high insulin dosages.

Question 22

How should we treat odontogenic infections?

Answer 22

extraction
incision and drainage (I&D)
antibiotics