Module 12 Exam 2 Flashcards
What is diabetes mellius
a group of metabolic diseases characterized by hyperglycemia
what does hyperglycemia result from
and insulin deficiency, resistance to insulin or both
What is chronic hyperglycemia associated with
long term damage, dysfunction, and failure of numerous organs, especially the eyes, kidneys, nerves heart, and blood vessels
what becomes more prevalent as the population ages and obesity increases
diabetes
What is insulin
a hormone produced by the beta cells in the pancreas
what does insulin effect
it directly or indirectly effects every organ in the body
what does insulin enable
glucose transport into cells to use as energy
what are the main functions of insulin
- facilitates glucose uptake from blood into tissues
- speeds oxidation of glucose within cells for energy
- speeds conversion of glucose to glycogen to store in the muscles to prevent it converting back to glucose
- conversion of glucose to fat in adipose tissue
what are normal blood glucose levels in healthy individuals
60-150 mg/dl
what happens with the increased glucose in the blood in type 1 diabetes
it spills over into the urine, causes excretion of large amts of urine, causes water and electrolyte loss, which signals thirst in the brain
What may cells in Type 1 diabetes starving for glucose cause the patient to do
increase food intake, but weight loss may still occur
Without glucose for energy in Type 1 was does the body do for energy
metabolizes fat for energy
what does the metabolism of fat end in
harmful ketones that accumulate in the blood
what are ketones
when in large quantity body cant handle and it causes metabolic acidosis
what can metabolic acidosis lead to
a diabetic coma
does the insulin production and secretion by the pancreas remain at normal levels in type 2 diabetes
yes
what happens in type 2 diabetes
-insulin receptors develop defects and glucose cant be transmitted to the cell
what level increases as the insulin resistance of the cells increase
blood glucose levels
What is hypoglycemia/insulin shock
-too much insulin which lowers level of blood glucose
what is the more common emergency likely to occur in the dental setting, hyper or hypo
hypoglycemia
what is hyperglycemic reaction/ diabetic coma (ketoacidosis)
too little insulin, increased levels of blood glucose
What is type 1 diabetes
-absolute insulin deficency resulting from the destruction of the insulin-producing beta cells in the pancreas
When does type 1 diabetes usually arise
childhood or puberty
what are former names of type 1 diabetes
-insulin dependent diabetes mellitus, juvenile diabetes, juvenile onset, ketosis-prone diabetes, brittle diabetes
what is type 2 diabetes
pancreatic insulin secretion may be low, normal, or even higher than normal but the patient exhibits an insulin resistance that impairs the use of insulin
what is gestational diabetes mellitus
any degree of glucose intolerance with onset or first recognition during pregnancy
what is gestational diabetes related to
genetics, obesity, hormones
when is gestational diabetes diagnosis reclassified
6 weeks after pregnancy ends
what has lessened the danger of gestational diabetes for the mother
insulin adjustment, carefully supervised prenatal care, improved obstetrics
What are characteristics of the pregnancy and baby in a mother with gestational diabetes
- larger infant
- premature births more freq
- congential malformations, perinatal death
- tendency to develop type 2 diabetes later in life
What do other types of diabetes result from
-genetic defects, diseases, endocrinopathies, surgery, drugs, malnutrition, infections, injury
what are some genetic defects that cause diabetes
- genetic defects of the beta cell, or insulin action
what are some diseases of the exocrine pancreas that cause diabetes
- diseases that injure or destroy beta cells
- pancreatitis, trauma, pancreatectomy, carcinoma, cystic fibrosis
what are endocinopathies that cause diabetes
- HGH, cortisol, glucagons, epi antagonize insulin action
- acromegaly, cushing syndrome, hyperthyroidism
what do drugs or chemicals do to induce diabetes
- chemicals impair insulin secretion, insulin action, destroy betal cells
- glucocorticoids, thyroid hormone, dilantin, thiazides
what do infections do to cause diabetes-
- viruses can destroy beta cells
- congenital rubella, cytomegalovirus, mumps
what are some syndromes associated with diabetes
- down sydrome
- huntingtons disease
- prader willi syndrome
what are symptoms of hyperglycemia
polyuria polydypsia weight loss polyphagia blurred vision increased susceptibility to infections impaired growth
to diagnose diabetes what should the a1c number be over
6.5%
to diagnose diabetes what is the fasting glucose over
126 mg/dl
to diagnose diabetes what is the 2 hour plasma glucose greater than
200 mg/dl
What are the complications of diabetes relating to infections
-patients are more susceptible to infections
-failure to treat intensifies symptoms of diabetes
-
what may cause insulin requirements to increase
fever, infection, inflammation, trauma, bleeding, pain, or stress
What is peripherial neuropathy
- pain, numbness, or tingling of mouth, face and extremities
- leads to increased incidence of amputations because of delayed ID of problems
what is autonomic neuropathy
- can cause GI symptoms
- food is delayed in stomach, leading to a delay in adsorbtion, and complications managing blood glucose
what is nephropathy
- diabetes is the leading cause of renal disease, and most common of end stage renal disease
- dialysis or kidney transplant may be needed
what is retinopathy
- diabetes is leading cause of blindness
- patients are more likely to have glaucoma and cataracts
what are the complications of diabetes and cardiovascular disease
-heart disease
-peripherial vascular disease
-cerebrovascular disease
-hypertension
may lead to myocardial infarction and stroke
what is a major cause of limb amputation
diabetes
pregnant patients who have diabetes are at a higher risk for
spontaneous abortion, miscarriages, babies with birth defects, increased weight
What are the psychosocial problems of diabetes
-tx regimens challenging to cope with, lead to emotional and social problems, including depression
Diabetes is known as
the silent killer
what does diabetes reduce
average life span, diabetes and its complications are leading causes of death
what are the general procedures for someone who has diabetes
- early diagnosis
- education for self care
- maintain best overall health
- maintain tight glycemic control
- immediate tx for acute symptoms
What is an essential part of the tx program which lowers insulin requirements, cardiovascular risk factors
exercise
what can many cases of type 2 diabetes be controlled with
weight reduction and exercise alon
what are goals of medical nutritional therapy
prevent and manage diabetes and slow the development of complications
what are the fundamentals of the diet for a diabetic
-high fiber, low fat, low cholesterol, low sodium
What should we know about tobacco use and diabetes
- pt must avoid all types of tobacco
- increases risk of heart disease, stroke, MI, limb amputations, perio disease, numerous health problems
Why should diabetic pts avoid excess alcohol?
-can raise blood pressure and contribute to other health problems
Do type 1 and type 2 require exogenous insulin?
yes- type 1 for survival and type 2 for control
What are the different types of insulin
-rapid, short, intermediate, or long acting based on the onset, peak and duration of action
what does the dosage of insulin depend on
-the individual
what factors affect the need for insulin
-food intake, illness, stress, variations in exercise, infections
what are the methods for insulin administration
- insulin pen
- sub Q injection with syringe
- continuous sub Q insulin infusion with a battery operated insulin pump
- inhalable insulin
what are oral hypoglycemic medications used to treat
type 2 in conjunction with diet, exercise, and possibly injection of insulin
what has pancrease transplantation eliminated the need for
exogenous insulin in type 1 patients
What findings in the gingva occur with diabetes
increased gingival inflammation
what findings with the periodontium occur in diabetes
- periodontitis
- attachment loss
- deep pockets
- alveolar bone loss
- tooth mobility and migration
- healing delayed
what findings with teeth occur in diabetes
- increased risk of caries related to decreased saliva, diet in poorly controlle diabetes
- in well controlled: caries related to low sugar, regular habits, maintenance
what findings with the lips occur in diabetes
-dry, cracking, angular chelitis
what findings with the saliva occur in diabetes
- decreased flow
- glucose in sulcular fluid
- xerostomia
what findings with the mucosa occur in diabetes
- edematous, red
- candidiasis
- burning mouth or tongue
- delayed healing
- increase lichen planus,
what findings with taste occur in diabetes
-hypogeusia, diminished taste perception
Perio infections may also affect control of blood glucose by increasing what
insulin resistance in a manner similar to obesity
patients with uncontrolled glucose levels have more severe what
perio disease at younger ages
diabetes does not cause oral disease but may lower what and increase what
resistance and susceptibility to oral findings
what can affect blood sugar levels during a dental appointment
stress
When is antibiotic premedication indicated
routine dental tx is deferred until diabetes is stabilized, consult for premed
What time should you treat a patient
- treat on a full stomach
- avoid peak insulin level
- ideal time varies with each patient
what precautions should be taken in a patient with diabetes
- dont keep waiting
- dont interfere with regular meal
- avoid long stressful procedures
- prevent and treat all infections
- prep. for diabetic emergencies
what is diabetes insipidus
a rare disease characterized by polyuria, polysdipsia indued by antidiuretic hormone defect
