Diabetes Mellitus Flashcards
pathophysiology of diabetes mellitus
- metabolic disease
- inability to produce and/or use insulin
- slectively damages a certain subset of cell types
pts with DM are hyperglycemic or hypoglycemic?
hyperglycemic (high blood glucose levels)
which subset of cell types cannot tolerate or regulate in a hyperglycemic state and are damaged?
- capillary endothelia cells in retina
- mesangial cells in glomerulus
- neurons and Schwann cells in brain
what are some independent accelerating factors that will pre-dispose ppl for certain complications of DM?
- hypertension
- hyperlipidemia
what are the type types of DM?
- Type 1
- Type 2
Type 1 DM
insulin deficiency secondary to autoimmune destruction of pancreatic beta cells
Type 2 DM
insulin resistance secondary to genetic, environmental and aging factors
what is the most common type of diabetes?
Type 2
systemic complications of diabetes
- retinopathy
- cerebrovascular disease
- coronary heart disease
- nephropathy
- peripheral vascular disease
- neuropathy
- ulceration and amputation
diabetes leads to what CV effects?
accelerated atherosclerosis (CAD)
risk of stroke and CAD death is how many times higher in diabetics?
2-4x
what is the leading cause of death in type 2 diabetics?
MI
diabetics are 25x more likely to acquire what than those without diabetes?
end-stage renal disease (ESRD)
what is the leading cause of death in type 1 diabetics?
ESRD
HbA1C
- tests amount of sugar attached to hemoglobin
- monitors pt’s progress
what does an HbA1C indicate?
glycemic level over last 2-3 months
how often do controlled diabetics have to get their HbA1C drawn?
2x/yr
how often do uncontrolled diabetics have to get their HbA1C drawn?
4x/yr
HbA1C for non-diabetics
<6%
HbA1C for well-controlled diabetics
<7%
T/F: systemic complications increase with increasing A1C
true
pts with <7% A1c have what percent of fewer systemic complications?
42%
pts with <7% A1c have what percent of fewer deaths than those with >8% A1c?
57%
what is the goal of monitoring pt’s A1c?
strict glycemic control
general medical management of diabetics
- 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
med management of type 1 diabetics
- injectable insulin-subcutaneous
- combo of long and short-acting agents
- multiple dosing throughout day
long-acting agents mimic what?
normal basal secretion
short-acting agents mimic what?
meal-time secretion
external insulin pumps
- for pts who are not compliant
- catheter in abdominal wall
- constant basal infusion, pt boluses at meals
med management of type 2 diabetics
- lifestyle mods
- control risk factors for CV disease
- drug therapy
how can you manage risk factors for CV disease in type 2 diabetics?
- BP & lipid control
- ASA for antiplatelet therapy (to decrease risk for developing clots)
drug therapy for type 2 diabetics
- 1 or more hypoglycemics
- +/- injectables
dental txtment for controlled diabetics
- any elective care is okay (surgery is fine too)
- prevention of problems secondary to oral hypoglycemics or insulin
- check glucose prior to starting txtment
dental txtment concerns with uncontrolled diabetics
- infection
- poor wound healing
- systemic risk
how do you txt an uncontrolled diabetic with a hot tooth?
- aggressive management
- strict glycemic control
should you perform elective surgery on pts with uncontrolled diabetes?
no
what systemic risks are uncontrolled diabetics at risk for?
- HTN
- CAD
- stroke
acute odontogenic infection in diabetics
- infection can lead to loss of diabetic control
- loss of diabetic control can lead to aggressive infection
are you more concerned about an acute odontogenic infection in what type of diabetics?
- uncontrolled and brittle diabetics
- type 1 diabetics on high insulin dosages
goal of management of acute infection
cure infection and restore glycemic control
how can you treat an acute odontogenic infection in uncontrolled diabetics?
- ext
- incision and drainage
- antibiotics
hypoglycemia secondary to too much insulin or too little food is considered what?
an emergency
what are the 3 clinical stages of hypoglycemia secondary to too much insulin or too little food?
- mild
- moderate
- severe
mild clinical stage of hypoglycemia secondary to too much insulin or too little food
- hunger
- weakness
- sweating
- tachycardia
moderate clinical stage of hypoglycemia secondary to too much insulin or too little food
- incoherent
- uncooperative
- belligerent
- disorientation
severe clinical stage of hypoglycemia secondary to too much insulin or too little food
- unconscious
- hypotensive
- tachycardia
txtment of insulin rxn in conscious pts
- give oral sugar
- should be better within 5 minutes
txtment of insulin rxn in unconscious pts
- EMS
- glucagon injection
- BLS prn
normal blood glucose
between 70-200
how can you prevent insulin shock in diabetic pts?
- instruct pts to follow normal insulin regimen and eat normally around appt
- morning appt
- confirm they ate and took insulin/hypoglycemics
- instruct pts to notify you ofsyms during the office visit
- source of sugar in the office
