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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 _____

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
what is the test for monitoring diabetes
FPG on 2 or more occassions
26
what is the normal FPG
70-110 mg/dl
27
what is the prediabetes FPG
110 to 125 mg/dl
28
what is the diabetes FPG
126 mg/dl or higher
29
for those that dont have diabetes 2 hours post prandial glucose is:
less than 160 mg/dL
30
2 hours postprandial glucose for those who have diabetes is:
less than 180mg/dL
31
capillary blood glucose is ____ to arterial. and venous glucose is _____ than arterial
closer, lower
32
venous glucose is _____ than arterial
lower
33
what goes glycosylated hemoglobin test indicate
average blood sugar for past 2-3 months. measures percent of blood sugar attached to hemoglobin
34
what is the gold standard for assessing long term glycemic control
Hba1c
35
what is the normal Hba1c
less than 5.7%
36
what is the prediabetes Hba1c
5.7-6.4%
37
what is the diabetes hba1c
6.5% or higher
38
what is the hba1c goal for most adults with diabetes
less than 7%
39
what is the life expectancy for diabetes
22-24 years less than average
40
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)
41
what are the surgical complications associated with DM
- delayed wound healing - increased risk of post operative infection
42
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)
43
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)
44
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
45
what blood glucose is considered hypoglycemia
less than 70mg/ml
46
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
47
hypoglycemia is _____ if not tended to immediately
life threatening
48
hypoglycemia can be either:
mild, moderate or severe
49
in mild and moderate stages does the pt lose consciousness
no
50
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
51
what is the 15:15 rule
wait 15 minutes for sugar to get into blood and eat 15 grams of carbohydrate
52
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
53

Oral Medicine and Diagnosis (12 decks)

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