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Oral Medicine and Diagnosis > Management of Patients with Diabetes Mellitus > Flashcards

Management of Patients with Diabetes Mellitus Flashcards

1
Q

what are the two major types of diabetes mellitus

A
  • type 1: insulin dependent DM
  • type 2: non insulin dependent diabetes mellitus
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2
Q

what are the other types of DM

A
  • type III- other types of diabetes (drugs, pancreas, or hormonal disease)
  • gestational diabetes
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3
Q

DM affects _____ americans or ______% of the population

A

30.3 million; 9.4

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4
Q

of the 30.3 million americans ____ were diagnosed, and _____ were undiagnosed

A

23.1 million, 7.2 million

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5
Q

about 5% of american people with diabetes are estimated to have _____ diabetes

A

type 1

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6
Q

in 2015 as estimated _____ new cases of diabetes were diagnosed among US adults aged 18 years or older

A

1.5 million

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7
Q

more than half of the new cases were adults aged _______

A

45-64 years

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8
Q

DM is the _____ leading cause of death in the US

A

seventh

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9
Q

what is associated with DM

A

kidney disease, high BP, retinopathy, neuropathy, stroke, foot complications

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10
Q

DM is the ____ cause of blindness in the US

A

leading

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11
Q

type I diabetes occurs when:

A

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

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12
Q

type 1 DM is usually diagnosed in:

A

children and adults

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13
Q

type 1 DM is previously known as:

A

juvenile diabetes

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14
Q

what age is type 1 DM common in

A

peak age at dx is around 14 years

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15
Q

what percentage of diabetic pts in the US have type 1 diabetes

A

5%

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16
Q

can adults get type 1 DM

A

yes

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17
Q

type 1 dm requires ____ insulin

A

exogenous

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18
Q

what are the signs and symptoms for type 1 diabetes

A
  • age of onset - 15 years
  • polydipsia
  • polyuria
  • polyphagia
  • weight loss
  • dry mouth
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19
Q

type 2 diabetes is usually seen in what age

A

adults

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20
Q

type 2 diabetes is _____ of diabetic population

A

95%

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21
Q

what are the 3 cardinal abnormalities in type II diabetes

A
  • resistance to insulin action in peripheral tissues
  • defective insulin secretion
  • increased liver glucose production
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22
Q

the clinical onset of type II DM is _____

A

slow

23
Q

blood sugar levels are _____ stable so ketacidosis is _______

A

more; uncommon

24
Q

what are the signs and symptoms of type II DM

A
  • age of onset: 40 years
  • slight weight loss/gain
  • nocturnal urination
  • blurred/decreased vision
  • paresthesias/loss of sensation
  • postural hypotension
25
Q

what is the test for monitoring diabetes

A

FPG on 2 or more occassions

26
Q

what is the normal FPG

A

70-110 mg/dl

27
Q

what is the prediabetes FPG

A

110 to 125 mg/dl

28
Q

what is the diabetes FPG

A

126 mg/dl or higher

29
Q

for those that dont have diabetes 2 hours post prandial glucose is:

A

less than 160 mg/dL

30
Q

2 hours postprandial glucose for those who have diabetes is:

A

less than 180mg/dL

31
Q

capillary blood glucose is ____ to arterial. and venous glucose is _____ than arterial

A

closer, lower

32
Q

venous glucose is _____ than arterial

A

lower

33
Q

what goes glycosylated hemoglobin test indicate

A

average blood sugar for past 2-3 months. measures percent of blood sugar attached to hemoglobin

34
Q

what is the gold standard for assessing long term glycemic control

A

Hba1c

35
Q

what is the normal Hba1c

A

less than 5.7%

36
Q

what is the prediabetes Hba1c

A

5.7-6.4%

37
Q

what is the diabetes hba1c

A

6.5% or higher

38
Q

what is the hba1c goal for most adults with diabetes

A

less than 7%

39
Q

what is the life expectancy for diabetes

A

22-24 years less than average

40
Q

what are the vascular complications associated with diabetes

A

-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)

41
Q

what are the surgical complications associated with DM

A
  • delayed wound healing
  • increased risk of post operative infection
42
Q

what are the medication managament regimens for diabetes

A
  • oral hypoglycemics: tolbutamide, glyburide, glipizide
  • insulin: regular, NPH, lantus insulin, protamine zinc (rapid, intermediate and long acting)
43
Q

what is the dental management of the diabetic patient

A
  • 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)
44
Q

what should be considered with dental appointments and diabetic pts

A
  • 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
45
Q

what blood glucose is considered hypoglycemia

A

less than 70mg/ml

46
Q

what is hypoglycemia from in diabetics

A

usually from pt not eating normally but still taking their regular insulin therapy
- can occur from over dosage of insulin

47
Q

hypoglycemia is _____ if not tended to immediately

A

life threatening

48
Q

hypoglycemia can be either:

A

mild, moderate or severe

49
Q

in mild and moderate stages does the pt lose consciousness

A

no

50
Q

what is dental management of the hypoglycemic patient

A
  • 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
51
Q

what is the 15:15 rule

A

wait 15 minutes for sugar to get into blood and eat 15 grams of carbohydrate

52
Q

what is dental management of the severe hypoglycemic patient

A
  • 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
53
Q
A

Oral Medicine and Diagnosis (12 decks)

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