Management of Patients with Diabetes Mellitus Flashcards
what are the two major types of diabetes mellitus
- type 1: insulin dependent DM
- type 2: non insulin dependent diabetes mellitus
what are the other types of DM
- type III- other types of diabetes (drugs, pancreas, or hormonal disease)
- gestational diabetes
DM affects _____ americans or ______% of the population
30.3 million; 9.4
of the 30.3 million americans ____ were diagnosed, and _____ were undiagnosed
23.1 million, 7.2 million
about 5% of american people with diabetes are estimated to have _____ diabetes
type 1
in 2015 as estimated _____ new cases of diabetes were diagnosed among US adults aged 18 years or older
1.5 million
more than half of the new cases were adults aged _______
45-64 years
DM is the _____ leading cause of death in the US
seventh
what is associated with DM
kidney disease, high BP, retinopathy, neuropathy, stroke, foot complications
DM is the ____ cause of blindness in the US
leading
type I diabetes occurs when:
the immune system destroys the insulin producing beta cells of the pancreas resulting in decreased or absent circulating insulin
type 1 DM is usually diagnosed in:
children and adults
type 1 DM is previously known as:
juvenile diabetes
what age is type 1 DM common in
peak age at dx is around 14 years
what percentage of diabetic pts in the US have type 1 diabetes
5%
can adults get type 1 DM
yes
type 1 dm requires ____ insulin
exogenous
what are the signs and symptoms for type 1 diabetes
- age of onset - 15 years
- polydipsia
- polyuria
- polyphagia
- weight loss
- dry mouth
type 2 diabetes is usually seen in what age
adults
type 2 diabetes is _____ of diabetic population
95%
what are the 3 cardinal abnormalities in type II diabetes
- resistance to insulin action in peripheral tissues
- defective insulin secretion
- increased liver glucose production
the clinical onset of type II DM is _____
slow
blood sugar levels are _____ stable so ketacidosis is _______
more; uncommon
what are the signs and symptoms of type II DM
- age of onset: 40 years
- slight weight loss/gain
- nocturnal urination
- blurred/decreased vision
- paresthesias/loss of sensation
- postural hypotension
what is the test for monitoring diabetes
FPG on 2 or more occassions
what is the normal FPG
70-110 mg/dl
what is the prediabetes FPG
110 to 125 mg/dl
what is the diabetes FPG
126 mg/dl or higher
for those that dont have diabetes 2 hours post prandial glucose is:
less than 160 mg/dL
2 hours postprandial glucose for those who have diabetes is:
less than 180mg/dL
capillary blood glucose is ____ to arterial. and venous glucose is _____ than arterial
closer, lower
venous glucose is _____ than arterial
lower
what goes glycosylated hemoglobin test indicate
average blood sugar for past 2-3 months. measures percent of blood sugar attached to hemoglobin
what is the gold standard for assessing long term glycemic control
Hba1c
what is the normal Hba1c
less than 5.7%
what is the prediabetes Hba1c
5.7-6.4%
what is the diabetes hba1c
6.5% or higher
what is the hba1c goal for most adults with diabetes
less than 7%
what is the life expectancy for diabetes
22-24 years less than average
what are the vascular complications associated with diabetes
-microangiopathy and atherosclerosis (macro)
- MI, CVA
- ulceration and gangrene of feet
- retinopathy
- nephropathy -> renal failure (ESRD)
- increased risk of post operative infection (sluggish neutrophil migration)
what are the surgical complications associated with DM
- delayed wound healing
- increased risk of post operative infection
what are the medication managament regimens for diabetes
- oral hypoglycemics: tolbutamide, glyburide, glipizide
- insulin: regular, NPH, lantus insulin, protamine zinc (rapid, intermediate and long acting)
what is the dental management of the diabetic patient
- thorough medical history
- type of diabetes (type 1 or type II)
- determine the status of the diabetic patient (well controlled or poorly controlled)
- oral surgical procedures including dental implant placement can be performed in a patient who is a well controlled diabetic
- if poorly controlled diabetic patient then obtain medical consult
- medications (insulin or oral hypoglycmeic)
- determine how the patient monitors their glucose levels (daily, weekly, monthly)
- results of last medical evaluation (good, fair, poor)
what should be considered with dental appointments and diabetic pts
- brief morning appointments (avoid lengthy appointments as they increase stress)
- anxiety reduction protocol
-monitor vitals before, during and after surgery - measure blood glucose before surgery
- patient should take normal insulin/oral hypoglycemic dosage and eat normal breakfast for procedures under LA
- always confirm this with patient before initiating any procedure
- for patients who are going to undergo surgical procedures under IV sedation, they should be on NPO and also receive 1/2 insulin dose and also get supplement with IV glucose
what blood glucose is considered hypoglycemia
less than 70mg/ml
what is hypoglycemia from in diabetics
usually from pt not eating normally but still taking their regular insulin therapy
- can occur from over dosage of insulin
hypoglycemia is _____ if not tended to immediately
life threatening
hypoglycemia can be either:
mild, moderate or severe
in mild and moderate stages does the pt lose consciousness
no
what is dental management of the hypoglycemic patient
- 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
what is the 15:15 rule
wait 15 minutes for sugar to get into blood and eat 15 grams of carbohydrate
what is dental management of the severe hypoglycemic patient
- pt looses consciousness
- stop the proceudre
- perform BLS
- patient should be in a supine position
- circulation, airway breathing
- summon EMS
- definitive management
- check blood glucose level
- give 50% dextrose IV or 1mg glucagon IM
