Management of patients with Diabetes Mellitus

Question 1

Diabetes Mellitus

Answer 1

Group of metabolic diseases characterized by high blood glucose level and the inability to produce and/or use insulin

Question 2

Diabetes Mellitus
Two Major Types:
(2)

Answer 2

Type I: Insulin-dependent diabetes mellitus (IDDM)
Type II: Non-insulin-dependent diabetes mellitus (NIDDM)

Question 3

Other Types
(2)

Answer 3

Type III – Other types of diabetes (drugs, pancreatic or hormonal disease)
Gestational Diabetes Mellitus (GDM) –Seen in pregnant patients

Question 4

Diabetes Mellitus - Facts
* Affects 30.3 million Americans, or –% of the population (2017).

Answer 4

9.4%

Question 5

Of the 30.3 million Americans, 23.1 million were diagnosed, and – million were undiagnosed.

Answer 5

7.2

Question 6

About 5% of American people with diabetes are estimated to have Type – diabetes.*

Answer 6

1

Question 7

In 2015, an estimated – million “new cases” of diabetes were diagnosed among U.S. adults aged 18 years or older.

Answer 7

1.5

Question 8

More than half of these new cases were among adults aged

Answer 8

45 to 64 years.

Question 9

— leading cause of death in U.S (2015).

Answer 9

Seventh

Question 10

Systemic effects
(6)

Answer 10

Kidney disease (Nephropathy),
High blood pressure,
Retinopathy,
Neuropathy,
Stroke,
Foot complications etc.,

Question 11

Leading cause of — in U.S.

Answer 11

blindness

Question 12

Type I diabetes occurs when the

Answer 12

immune system destroys the insulin-producing beta cells of the
pancreas resulting in decreased or absent circulating insulin

Question 13

1
It is usually diagnosed in children and young adults, and was previously known as

Answer 13

Juvenile diabetes.

Question 14

1
More common in

Answer 14

adolescents (peak age at diagnosis is around14 years).

May develop in adults.

Question 15

1
Only –% of diabetic patients in the United States have this form of the disease.

Answer 15

5

Question 16

1
Requires …

Answer 16

exogenous insulin

Question 17

IDDM-Signs and Symptoms
(7)

Answer 17

• Sudden onset of symptoms
• Age of onset: 15 years
• Polydipsia
• Polyuria
• Polyphagia
• Wt. Loss
• Dry mouth

Question 18

2
* Usually seen in —

Answer 18

adults

Question 19

2
– % of diabetic population.

Answer 19

95

Question 20

2
3 Cardinal abnormalities:
(3)

Answer 20

• Resistance to insulin action in peripheral tissues
• Defective Insulin secretion
• Increased liver Glucose production

Question 21

2
Clinical onset —.

Answer 21

slow

Question 22

2
Blood sugar levels much more stable so — uncommon.

Answer 22

Ketoacidosis

Question 23

NIDDM - Signs and Symptoms
(7)

Answer 23

• Gradual onset of symptoms
• Age of onset: 40 years
• Slight wt. Loss/ gain
• Nocturnal urination
• Blurred / decreased vision
• Paresthesias / loss of sensation
• Postural hypotension

Question 24

Laboratory Investigations for Monitoring Diabetes
Fasting Plasma Glucose (FPG)
— or more occasions
Normal:
Prediabetes:
Diabetes:

Answer 24

2
70 to 110 mg/dl
110 mg/dl to 125 mg/dl
126 mg/dl or higher

Question 25

Laboratory Investigations for Monitoring Diabetes 2 hour postprandial * For those who don't have diabetes: * For those who have diabetes: Capillary blood glucose is closer to ---

Answer 25

less than 160 mg/dL. less than 180 mg/dL. arterial (venous glucose is lower than arterial)

Question 26

Glycosylated hemoglobin (A1C) test:

Answer 26

indicates average blood sugar for past 2-3 months. Measures percent of blood sugar attached to Hemoglobin. Considered as “Gold Standard” for assessing long-term glycemic control

Question 27

A1C Normal: Prediabetes: Diabetes:

Answer 27

less than 5.7% 5.7% to 6.4% 6.5% or higher

Question 28

The goal for most adults with Diabetes is and HbA1c that is less than --%

Answer 28

7

Question 29

Diabetes – Long Term Medical Complications * Decreasing life expectancy

Answer 29

* 22 – 24 years less than average

Question 30

Diabetes – Long Term Medical Complications Vascular complications (6)

Answer 30

* Microangiopathy and athersclerosis (macro) * MI, CVA * Ulceration and gangrene of feet * Retinopathy) * Nephropathy → renal failure (ESRD) * Increased risk of post operative infection (Sluggish Neutrophil Migration)

Question 31

Surgical Complications Associated with Diabetes Mellitus (2)

Answer 31

* Delayed wound healing * Increased risk of post-operative infection

Question 32

Medical Management of the Diabetic Patient Oral Hypoglycemics Rx: (2)

Answer 32

* Tolbutamide * Glyburide, glipizide

Question 33

Medical Management of the Diabetic Patient Insulin * Types: (4)

Answer 33

regular, NPH, lantus insulin and protamine zinc (rapid, intermediate and long acting)

Question 34

Dental Management of the diabetic patient - Thorough --- - Type of Diabetes (Type I or Type II) - Determine the status of the diabetic patient: - --- can be performed in a patient who is a well controlled diabetic. - If poorly controlled diabetic patient, then obtain ---. - Medications: - Determine how the patient monitors their glucose levels: - Results of last medical evaluation: --- appointments ( Avoid lengthy appointments as they increase stress) ----reduction protocol Monitor --- before, during and after surgery Measure --- before surgery Patient should (2) for procedures under Local Anesthesia. Always confirm this with patient before initiating any procedure

Answer 34

medical history Well controlled or poorly controlled Oral surgical procedures including dental implant placement medical consult Insulin or Oral Hypoglycemic Daily, Weekly, Monthly Good, Fair, Poor Brief morning Anxiety vitals blood glucose take normal insulin/oral hypoglycemic dosage and eat normal breakfast

Question 35

or patients who are going to undergo surgical procedures under I.V Sedation ,they should be on

Answer 35

NPO(Nil Per Oral) and also receive ½ their insulin dose and also get supplement with I.V Glucose

Question 36

Hypoglycemia –

Answer 36

Serious Medical Emergency in the dental office.......

Question 37

Diabetes Mellitus - Hypoglycemia (6)

Answer 37

Low blood sugar (happens with diabetic and non-diabetic patients) * Blood glucose < 70 mg/ml. * Usually from pt. not eating normally but still taking their regular insulin therapy. * Can occur from over dosage of insulin. * Life threatening if not attended to immediately. * Hypoglycemia can be either mild, moderate or severe.

Question 38

Dental management of the hypoglycemic patient Mild and Moderate stages –Patient does not loose consciousness (5)

Answer 38

Recognize hypoglycemic signs and symptoms Terminate the procedure Give the patient anything containing sugar (15:15 rule) Position the patient in a comfortable position; If necessary perform BLS Summon medical assistance if necessary and monitor the patient

Question 39

Dental management of the hypoglycemic patient Severe Stage –Patient looses consciousness Unconscious patient Stop the procedure Perform --- Patient should be in a --- Position (P) Circulation, Airway Breathing (CAB) Summon EMS Definitive Management (D) Check --- Give (2)

Answer 39

BLS (PCABD) Supine Blood Glucose level 50% Dextrose IV or 1 mg Glucagon IM