Treating patients with diabetes mellitus Flashcards
List the four types of diabetes
Type 1
Type 2
Gestational diabetes
Pre- diabetes
Describe type 1 diabetes
- Antibodies attack insulin making cells in the pancreas, thus, cells cannot uptake sugar to use as energy
- As a result the body burns its own fats as a substitute
- Using fat as energy can result in of ketoacidosis
- Patients with type 1 diabetes depend on insulin injections daily
Describe type 2 diabetes
- In type 2 diabetes, the pancreas cannot make enough insulin/ the body is resistant to it
- Diabetes medications or insulin injections may also be required to control blood sugar levels
- Associated with lifestyle risk factors including poor diet, high blood pressure insufficient physical activity and overweight or obesity
List the signs and symptoms of type 1 diabetes
- Excessive thirst and dehydration
- Frequent urination
- Hunger, accompanied by weight loss
- Blurred vision
- Weakness, tiredness, or sleepiness
- Vomiting or nausea
- Sudden irritability
List the signs and symptoms of type 2 diabetes
- Fatigue
- Excessive thirst
- Frequent urination
- Blurred vision
- Mood changes
- High rate of infections
- Slow healing process
Describe gestational diabetes
- The demand for insulin increases in pregnancy. If the body is unable to keep up with this demand, gestational diabetes develops.
- Also, the placenta produces hormones which can block the action of the mother’s insulin (insulin resistance)
- The condition usually disappears once the baby is born
- Increased risk of developing Type 2 Diabetes in the future for mother and baby
Describe pre-diabetes
- Impaired fasting glucose: too much glucose released from the liver overnight into the bloodstream
- Impaired glucose tolerance Not enough insulin produces or does not work properly or a combination of both
List long term complications of diabetes
- Retinopathy- damage to the retina can lead to blindness
- Nephropathy-kidney disease-damage to the kidneys
- Neuropathy- injury to blood vessels supplying the nerves-inability to feel pain
- Muscle weakness
- Cholesterol (heart failure, stroke)
List oral manifestations of diabetes.
Describe the link between diabetes and periodontitis
- Candidiasis/ Infection
- Caries
- Xerostomia
- Burning mouth syndrome
- Impaired wound healing
- Increased glucose in saliva
- Dysgeusia
- Increased risk for periodontitis and periodontitis has a negative effect on glycaemic control
Describe the types of medications used by diabetics and their physiology
- In the form of tablets and injections
- They work by reducing the amount of glucose released by the liver, slowing the absorption of glucose and making the body more sensitive to the insulin
List the ranges of BGL
- 4.0 and 10.0 = treatment proceeds as normal
- If BGL exceeds 10.0 or monitor gives abnormal result, repeat test
- If on second test BGL exceeds 14.0 (within 2 hours of taking a meal), your patient may need to be reappointed- consult with your Clinical Educator or DO
Describe the histological effect of diabetes and the periodontium
- Increased glucose levels in blood and GCF which causes selection of periodontal pathogens
- Degenerative vascular changes (decreased oxygen utilisation, waste elimination and PMN migration)
- Decreased fibroblast function
- Altered collagen (altered metabolism, decreased synthesis, increased collagenase activity)
- PMN function (decreased chemotaxis, adherence, phagocytosis & oxidative killing)
- Increased pro-inflammatory cytokines (IL-1β & TNF-α)
Discuss the impacts of diabetes on vascular TISSUES and talk about HbA1c
- High BGL cause the endothelial cells lining the blood vessels to take in more glucose
- These cells form more glycoproteins on their surface and the basement membrane becomes thicker and weaker
- The walls of the vessels become thick but weak and results in bleeding, leaked protein and a slow flow of blood through the body
- Some cells therefore do not get enough blood and may be damaged. e.g. diabetic retinopathy, diabetic nephropathy and diabetic neuropathy
- HbA1c:refers to glycatedhaemoglobin (glucose attached to the haemoglobin)
- The higher the HbA1c, the greater the risk of developing diabetes-related complications
Describe hypoglycemia and hyperglycemia and patient management
Hypoglycemia
• Low blood sugar
• Give sweets (glucose gel under tongue)
Hyperglycemia
• Excess blood sugar
• Call 000 or 2222
Discuss the management of diabetes during treatment
Medical history:
• Need to determine whether Type 1 or Type 2
• Determine if meds have been taken
• Determine when patient has last eaten
Vital signs
• Determine when BGL was last checked, and value measured
• Check BG prior to treatment
• Record the BGL in patient file
