Management of patients with Diabetes Mellitus Flashcards
Diabetes Mellitus
Group of metabolic diseases characterized by high blood glucose level and the inability to produce and/or use insulin
Diabetes Mellitus
Two Major Types:
(2)
Type I: Insulin-dependent diabetes mellitus (IDDM)
Type II: Non-insulin-dependent diabetes mellitus (NIDDM)
Other Types
(2)
Type III – Other types of diabetes (drugs, pancreatic or hormonal disease)
Gestational Diabetes Mellitus (GDM) –Seen in pregnant patients
Diabetes Mellitus - Facts
* Affects 30.3 million Americans, or –% of the population (2017).
9.4%
Of the 30.3 million Americans, 23.1 million were diagnosed, and – million were undiagnosed.
7.2
About 5% of American people with diabetes are estimated to have Type – diabetes.*
1
In 2015, an estimated – million “new cases” of diabetes were diagnosed among U.S. adults aged 18 years or older.
1.5
More than half of these new cases were among adults aged
45 to 64 years.
— leading cause of death in U.S (2015).
Seventh
Systemic effects
(6)
Kidney disease (Nephropathy),
High blood pressure,
Retinopathy,
Neuropathy,
Stroke,
Foot complications etc.,
Leading cause of — in U.S.
blindness
Type I diabetes occurs when the
immune system destroys the insulin-producing beta cells of the
pancreas resulting in decreased or absent circulating insulin
1
It is usually diagnosed in children and young adults, and was previously known as
Juvenile diabetes.
1
More common in
adolescents (peak age at diagnosis is around14 years).
May develop in adults.
1
Only –% of diabetic patients in the United States have this form of the disease.
5
1
Requires …
exogenous insulin
IDDM-Signs and Symptoms
(7)
- Sudden onset of symptoms
- Age of onset: 15 years
- Polydipsia
- Polyuria
- Polyphagia
- Wt. Loss
- Dry mouth
2
* Usually seen in —
adults
2
– % of diabetic population.
95
2
3 Cardinal abnormalities:
(3)
- Resistance to insulin action in peripheral tissues
- Defective Insulin secretion
- Increased liver Glucose production
2
Clinical onset —.
slow
2
Blood sugar levels much more stable so — uncommon.
Ketoacidosis
NIDDM - Signs and Symptoms
(7)
- Gradual onset of symptoms
- Age of onset: 40 years
- Slight wt. Loss/ gain
- Nocturnal urination
- Blurred / decreased vision
- Paresthesias / loss of sensation
- Postural hypotension
Laboratory Investigations for Monitoring Diabetes
Fasting Plasma Glucose (FPG)
— or more occasions
Normal:
Prediabetes:
Diabetes:
2
70 to 110 mg/dl
110 mg/dl to 125 mg/dl
126 mg/dl or higher
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 —
less than 160 mg/dL.
less than 180 mg/dL.
arterial (venous glucose is lower than arterial)
Glycosylated hemoglobin (A1C) test:
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
A1C
Normal:
Prediabetes:
Diabetes:
less than 5.7%
5.7% to 6.4%
6.5% or higher
The goal for most adults with Diabetes is and HbA1c that is less than –%
7
Diabetes – Long Term Medical Complications
* Decreasing life expectancy
- 22 – 24 years less than average
Diabetes – Long Term Medical Complications
Vascular complications
(6)
- 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)
Surgical Complications Associated with Diabetes Mellitus
(2)
- Delayed wound healing
- Increased risk of post-operative infection
Medical Management of the Diabetic Patient
Oral Hypoglycemics Rx:
(2)
- Tolbutamide
- Glyburide, glipizide
Medical Management of the Diabetic Patient
Insulin
* Types: (4)
regular,
NPH,
lantus insulin and
protamine zinc (rapid, intermediate and long acting)
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
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
or patients who are going to undergo surgical procedures under I.V Sedation ,they should be on
NPO(Nil
Per Oral) and also receive ½ their insulin dose and also get supplement with I.V Glucose
Hypoglycemia –
Serious Medical Emergency in the dental office…….
Diabetes Mellitus - Hypoglycemia
(6)
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.
Dental management of the hypoglycemic patient
Mild and Moderate stages –Patient does not loose consciousness
(5)
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
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)
BLS (PCABD)
Supine
Blood Glucose level
50% Dextrose IV or 1 mg Glucagon IM
