Diabetes-Related Emergencies Exam 3 Flashcards
What is Diabetes Mellitus?
Metabolic disorder characterized by
hyperglycemia
What is the etiology of Diabetes Mellitus?
- Reduction or absence of production of insulin
by beta cells of pancreas or defect of insulin
receptors
What does Insulin do?
Helps to aids in conversion of sugat and starches to a form transported to cells and used for energy
What are the three types of Diabetes mellitus?
- Type 1
- Type 2
- Gestations
- Prediabetes or impairedd glucose tolerance
Describe type 1 diabetes
- Absolute lack of insulin
- Pancreatic beta cells within Islets of Langerhan destroyed due to immune dysfunction
- Dependent on supplemental insulin for survival
Describe Type 2 diabetes
- On the rise due to increase life span, sedentary lifestyle and Poor diet and excerise
- Body is unable to produce enough insulin
- Body cannot use the insulin produced
What is Gestational diabetes?
Glucose intolerance- occurs during pregnancy
What is the cause of gestational diabetes and what can happen if left untreated?
Cause: Enzyme in placenta and destruction of insulin by placenta
Left untreated: Infant can have fetal macrosomia, hypoglycemia, hypocalcemia, or hyperbilirubinemia.
What are the different types of Diabetes tests?
A1C test - measure 2-3 months
- 5.7 normal 6.4 pre, 6.4 higher diabetes
Fasting plasma glucose test - 12-14 hour fasting
100-125 pre, 126 diabetes
Oral glucose tolerance test- Fast and drinking glucose drink
140-199 pre , >200 diabetes
What are the FIVE major systemic complications?
- Diabetic retinopathy
- Diabetic neuropathy
- Diabetic nephropathy
- Macrovascular and microvascular
- Oral manifestations
What is diabetic retinopathy
- Condition that is continuous from another disease/injury
- Leading cause if blindness ages 20-74
What is dibetic neuropathy?
- Pain in the feet and hands, slowed digestion, and
other neurological problems are common.
50% diabetics
What is diabetic Nephropathy?
- Damages of small blood vessels in kidneys
- Kidney failure- needs dialysis or transplant
What are the oral manifestations of diabetes?
Increased incidence of:
* Delayed wound healing leading to secondary
oral and systemic infections
* Periodontal disease
* Abscesses
* Xerostomia
* Caries
* Lichen planus
* Candidiasis
What are the medications and treatments for Type 1 diabeics?
- Insulin
- Can differ based on onset, peak effectiveness, effective duration and maximal duration
- Pumps
What are the medications and treatments for Type 2 diabeics?
- Medication based on cause and severity
- Medications: Metformin (Glucophage)
Rosiglitazone (Avandia), Tolbutamide (Orinase), Glyburide (Micronase, DiaBeta, Glynase)
What questions to ask all diabetic patients?
- Do you monitor glucose levels? If so, how often?
- What were your most recent glucose levels?
- How are you feeling?
- Do you take medication and if so, did you take it today?
- Have you eaten today? If so, when?
- Are you having problems with your eyes, feet, and/or legs?
- Do you see your physician regularly?
- Do you see an eye doctor yearly?
- Do you know your average hemoglobin value? HbA1C
What are some strategies to implement?
- Schedule appointments in early to mid-morning.
- Keep appointments short.
- Instruct patients to continue normal dietary intake prior to appointment.
- Check patientʼs blood glucose level prior to any invasive procedure or if patient complains of not feeling well.
- Frequent recall examinations and prophylaxis
- Use of topical fluoride
- Recommending saliva substitutes
What are some Diabetic medical emergencies?
- Diabetic ketoacidosis (DKA)
- Hyperosmolar Hyperglycemic Nonketotic
Syndrome (HHNKS) - Hypoglycemia
What is an uncommon occurence in a dental office?
Diabetic ketoacidosis (DKA)
What are the different types of patient affected by diabetic ketoacidosis?
- Newly diagnosed Type 1 diabetics
- Patients that are not medicating or eating properly
- Brittle diabetics
- Patients with infections
- Patients who use Alcohol and cocaine
What causes diabetic ketoacidosis?
- By prodcuts of fatty acides= blood to become more acidic- leads to tachypnea and Kussmaul respirations
What are some signs of DKA?
Altered mental state
Dehydrated
Skin and mucous warm and dry
Increase thirst
Muscle weakness and severe fatigue
Tachycardia
Hypotension
Vision blurred
Tachypnea and kussmaul
What is the treatment of DKA?
- Determine blood glucose level.
- Need to lower blood glucose level with insulin
- Should only be administered by medical professional to prevent hypoglycemia
- Contact EMS.
- IV fluids needed
- Monitor vital signs
- Give oxygen
T/F If unsure provide glucose as it will not significantly harm a DKA patient and it will significantly help a hypoglycemic patient.
True
What is HHNKS?
Hyperosmolar Hyperglycemic Nonketotic Syndrome- Patient will be hyperglycemic and dehydrated, but not acidotic.
What is Severe Hypoglycemia?
- AKA insulin shock
- Blood glucose level below 40-50
What are the signs and symptoms of severe hypoglycemia ?
Dizziness
fainting
weakness
headache
intense hunger
cold, clammy skin
profused perspiration
seizure
confusion
coma
irritability
Treatment of severe hypoglycemia conscious patient ?
- Eat/Drink 15g carbs
- wait 15 min
- check blood
- less than 70mg/dl, repeat steps
Treatment of severe hypoglycemia unconscious patient?
- Contact EMS
- Maintain airway
- Administer 20ml of 50% IV glucagon
- Monitor VS
- Give o2
