Part I Diabetes- Endocrine and Metabolic conditions Flashcards
What is the endocrine system?
- endorcine glands, hormones, cell changes
What does the endocrine system helps to regulate ?
- Cellular metabolism
- Growth and development of the body
- Reproduction function
- Blood sugar levels
What is diabetes mellitus ?
- Group of metabolic diseases characterized by high blood glucose and the inability to produce and or use insulin
- Affects all ages and genders
What does poorly controlled and untreated diabetes leads to?
- vascular disease
- Retinopathy- blindness
- Nephropathy- Kidney ESRD (End Stage-Renal Disease)
*Metabolic complication
How is diabetes mellitus relevance to dentistry?
- Bidirectional relationship with oral heath
- Diabetes weakens immune system
What occurs to the body when diabetes weakens immune system?
- Hyperglycemia: increase blood glucose -> saliva and sugar-> Caries and Periodontal disease
- Ketoacidosis-> lack insulin-> thirst, frequent urination, nausea, fruity breath, confusion
- Vascular wall disease -> prevent blood from circulating -> decreased ability to fight infection and poor wound healing
What are the four types of Diabetes?
- Type I
- Type II
- Gestational diabetes
- Other specific types
What is Type I diabetes?
- occurs in childhood or adolescence
- insulin deficiency caused by destruction of pancreatic beta cells
- Genetic condition and autoimmune mediated
What is Type II diabetes?
- Adult onset
- Insulin resistance and deficiency due to defects in insulin receptors
- Obesity, unhealthy lifestyle and poor die care
What is Gestational diabetes ?
- Abnormal glucose tolerance first appearing or detected during pregnancy
- Obesity is a risk factors: causes increase size in baby and risk for miscarriage
Define other specific types of diabetes?
Comes from the defect in beta cell functiona nd other diseases and infections ( cancer,thyroid disease and inflammation)
What are the signs and symptoms of Type I?
- Onset <40
- Polydipsia: Thirst
- Polyuria: Urination
- Polyphagia: Hunger
- Weight loss
- Loss of strength
- Malaise
- Irritability
- Drowsiness
- Bed wetting
- Blurred vision
- Ketoacidosis, which presents as:
Vomiting
Abdominal pain
Nausea
Tachypnea
Paralysis
Loss of consciousness
What are the signs and symptoms of Type-II?
- one set over the age of 40
- Associated with obesity
- Other symptoms like TYPE I
- Blurred or decreased vision
- Paresthesia (numbness and tingling)
- Dry flushed skin
- Loss of sensation
- Impotence (frequent urination and erectile disfunction)
- Vulvar pruritus
- Postural hypotension
What is type 1 vs type 2?
Type 1:
* Cannot be prevented or cured
* The body does not create enough insuline
* Causes are unknown but genetics may play a role
* Requires insuin injections for life
Type 2:
* Can be prevented through lifestyle modification
* The body does not creare enough insuline or develops resistance
* Causes include genetics, aging inactivity, obesity and more
* Requires insulin as needed injected or oral
What are the similarities between type 1 and type 2?
- Can cause other serious health problems and complications
- Requires a healthy lifestyle and medical supervision
- Symptoms include thirst, frequent urination and blurry vision
What is the previous name for type 1 diabetes?
- Insulin-dependent diabetes mellitus (IDDM)
- Juvenile Diabetes
- Childhood diabetes
What is the pervious name for type II diabetes?
- Non-insulin dependent
- Adult oneset diabetes
What are the percentages when it comes to type I and type II diabetes?
Type I: 5-10%
Type II: 90%
What are the different insullin production?
Type I: non or very little
Type II: too little or too ineffective
What are the different age of diagnosis for diabetes?
Type I: ages 0-40
Type II: 40 plus
What are the different treatment for Type I and Type II
Type I: healthy eating, increased physical activity, blood sugar checks, insulin injections
Type II: healthy eating, increased physical activity, blood sugar checks, insulin injections or oral medication (may be needed),
Diabetes diagnosis is made based on?
Level of blood glucose upon random sampling, after fasting or after a glucose tolerance test
Diabetes test uses the?
glycosylated hemoglobin- this shows a average level of control over 2-3 months
When is testing for diabetes recommended?
Recommended based on age and risk facotrs for the disease.
Ages 45 or older should get tested every 3 years
What is the goal of medical management for Type 1 ?
- Goal is to mimic physiologic insulin secretion
What is insulin shock?
- not enough calories plus normal insulin dose= excess insulin
- Hypoglycemia reffered to as insulin shock
What are the symptoms of insulin shock?
- Hunger
- Weakness
- Trembling
- Tachycardia
- Pallor
- Sweating
- Progession = incoherent, uncooperative, beligerent, lack judgement and disorientation
- Severe stage= unconsciousness and possible tonic or clonic muscle movement, sweating, palllor, rapid pulse, hypotension and hypothermia
What is the medical management for Type-II ?
- Begins with lifestyle modifications- diet, weightloss, reduction in risk facotrs for CVD
- Oral glucose lowering agents may be used alone or in conjunction with insulin therapy
- As condition progress therapeutic needs change
What is the goal of medical management for type II?
Manage gylcemic control, treat associated conditions and manage complications
ON TEST
What are the Glucose lowering agents ?
- Meltformin (biguanides)
- Glipizide and Glyburide
- Glinides
- Victoza, Ozempic
- Farxiga and Jardiance
What is the Dental Management for Diabetes?
- Evaluate for cardinal signs and symptoms
- If no diagnosis and symptoms are present, dismiss and refere to MD
- Well controlled patient, recieve treatment as indicated
- suspect DM if patient presents with headache, dry mouth, irritability, repeated skin infections, blurred vision, parethesia, progessive periodontal disease, abscessess, loss of sensation (Dismiss and refer to MD for testing)
- Diagnosed, fasting blood glucose level is 126 or more (dismiss and refer to MD)
If a patient is insulin dependent, what follow up questions should you ask?
Ask how much they use and how often they inject themselves.
When do you dismiss a patient?
- current or previous complications
- irregular monitoring
- if they cannot provide latest blood glucose level and latest HbA1c levels
- How often do they see physican if more than 6 months dismiss them
- If Pt has not taken meds as prescribed do not treat
What does Meltformin (biguanides) do?
Reduces glucose production in the LIVER and causes a slight increase in the bodys ability to use glucose for energy.
What does Glipizide and Glyburide (Insulin Secretagogues/Sulfonylureas) do?
Stimulate insulin production by interacting woth a componenet of a BETA CELL, should be taken with meal
What does Glinides do?
Work similary to sulfonylureas, but they work faster and for a shorter time
What does Victoza, Ozempic (incretins) do?
- Amplify the amount of insulin created when glucose is present
What does Farxiga and Jardiance (co-transporter 2 inhibitors) do?
INHIBIT GLUCOSE REABSOPRTION, lowers renal threshold for glucose and increases glucose excreted in the urine
What questions helps to prevent a medical emergency for patients with diabetes?
- Have you eaten today
- What time
- What did you eat
- Tell PT to know if they are experincing insulin reaction during appt.
Why are these question asked?
- If the patient took insulin or meds but did not eat, this puts then at risk for** hypoglycemia**
What are some Dental management, when it comes to medications?
- NSAIDS can enhance the effects of sulfonylureas
- Insulin dependent/uncontrolled may require **antibiotic premedication **
- Anesthesia: Epinephrine possibly raises blood glucose level- use with caution due to other conditions like CVD.
What are some oral manifestation for patient who has poorly controlled diabetes?
- Xerostomia
- Infections ( viral, fungal and bacterial)
- Poor wound healing
- Increased caries
- Gingivitis
- Periodontal disease
- Abscesses
- Burning mouth
Controlled oral health can help with diabetes true/false?
True
