Diabetes Mellitus Flashcards
Which diabetes is more common?
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.)
T/F. Diabetes suffer from peripheral nervous system and vascular (macrovascular and microvascular) systemic complications.
True.
T/F. The leading cause of death in Type 2 diabetes is End-Stage Renal Disease (ESRD).
False, It’s MI. The leading cause of death in Type 1 diabetes is End-Stage Renal Disease (ESRD).
What two ways is plasma glucose levels diagnostic of diabetes?
- fasting on two occasions ≥126mg/dL
2. random, ≥200mg/dL
What is HbA1C?
The amount of sugar attached to hemoglobin. It indicates the level of glycemic level over the last 2-3 months
glycosylated HbA1C = ≥6.5%
How often are patients HbA1C levels monitored if controlled and uncontrolled?
controlled - 2x/year
uncontrolled - 4x/year
What HbA1C values indicate the following:
- non-diabetic patients
- well-controlled diabetics
- less than 6%
2. less than 7%
T/F. Systemic complications increase with increasing A1C.
True, patients less than 7% have 42% fewer systemic complications and 57% fewer
death than those >8%
Goal = STRICT GLYCEMIC CONTROL!!
How is diabetes managed?
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
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
Type I diabetics
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)
Type II diabetics
External Insulin pumps place a catheter in the ___ wall and gives a constant basal infusion. The patient give themselves a bolus at ___.
abdominal; meals
What are some follow-up questions specific for diabetes?
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
T/F. Elective care should be done after consultation with a physician with controlled diabetics.
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.
With what glucose measurement should you defer or give carbs? defer elective treatment?
Less than 70 mg/dl : defer or give carbs
200 mg/dl: defer elective treatment
Define insulin reaction? What are the 3 clinical stages?
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
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?
mild & moderate; better within 5 minutes
severe: EMS and glucagon injection (SC/IM)
What can you do to help prevent insulin shock?
- Instruct patients to follow normal insulin regimen and eat normally around appointment
- Morning appointment
- Confirm that they ate and took insulin
- Instruct patient to notify you of symptoms during the office visit
- Source of sugar in the office
What are some dental treatment concerns for UNcontrolled diabetics?
infection (aggressive management, strict glycemic control) poor wound healing (avoid elective perio/oral surgery) systemic risk (HTN, CAD, renal disease, stroke)
T/F. With acute odontogenic infections, infection can lead to loss of diabetic control and loss of diabetic control can lead to aggressive infections.
True.
T/F. You should be more concerned about Type 1 diabetics on high insulin dosages instead of uncontrolled, and brittle diabetics.
False, You should be more concerned about uncontrolled, and brittle diabetics instead of Type 1 diabetics on high insulin dosages.
How should we treat odontogenic infections?
extraction
incision and drainage (I&D)
antibiotics
