Type 1 Diabetes Mellitus

Question 1

What is diabetes?

Answer 1

persistent hyperglycaemia

Question 2

How does Type 1 diabetes occur?

Answer 2

• autoimmune destruction of beta cells
  
  • islets of Langerhans in pancreas
• lack of insulin
  
  • hyperglycaemia
  • polyuria and dehydration

Question 3

What age does Type 1 diabetes most commonly present?

Answer 3

12-13 years

Question 4

What are the symptoms of Type 1 diabetes?

Answer 4

• polyuria
• excessive third
• lethargy
• weight loss

Question 5

Who makes up the multidisciplinary team for type 1 diabetes?

Answer 5

• paediatric endocrinologist
• paediatric diabetes specialist nurse
• paediatric dietician
• clinical psychologist
• adult endocrinologist/diabetic specialist
• social worker

Question 6

What random blood glucose value indicates a Type 1 diabetes diagnosis

Answer 6

> 11.0mmol/l

• markedly raised

Question 7

How is Type 1 diabetes managed?

Answer 7

• subcutaneous administration of insulin
• education
  • comprehensive
  • administration of insulin
  • signs of diabetes ketoacidosis
  • signs of hypoglycaemia
  • monitoring of blood glucose

Question 8

What dental problems may be associated with Type 1 diabetes?

Answer 8

• increased susceptibility to periodontal disease
• reduced salivary flow
• increased caries rate
• candidosis
  
  • in poorly controlled diabets
• infection
  
  • can affect blood glucose control
  • precipitate hypoglycaemic attack
  • rapid and aggressive treatment required

Question 9

What must be considered when providing treatment for a patient with Type 1 diabetes?

Answer 9

• prioritise prevention
  
  • enhanced prevention regime
• timing of appointments
  
  • particularly for treatment with LA
  • early to mid-morning
    
    • usual breakfast and insulin
    • usual lunch
    • diabetic control maintained
• general anaesthesia
  
  • closely liaise with endocrinologist
  • overnight admittance pre and post op
  • fasting required so control must be good
• anxiety
  
  • injecting with insulin every day
    
    • doesn’t mean won’t be anxious
    • awareness of potential to be unpleasant
• fatigue with care
  
  • fed up with constant instructions

Question 10

What is HbA1c?

Answer 10

test for glycated haemoglobin

Question 11

In a diabetic patient, what should HbA1c be below?

Answer 11

• 48mmol/mol
  
  • 6.5%

Question 12

In a patient without diabetes, what HbA1c would indicate a risk of type 2 diabetes?

Answer 12

• 42-48mmol/mol
  
  • 6%

Question 13

What would the HbA1c be in a patient without diabetes?

Answer 13

• <42mmol/mol
  
  • <6%

Question 14

What precautions must be taken when carrying out dental treatment for a patient with diabetes?

Answer 14

• ensure patient has eaten before appointment
  
  • appointment shouldn’t cross mealtimes
  • insulin delivery as normal
• determine level of diabetes control
  
  • HbA1c
    
    • <48mmol/mol OR 6.5%
  • if not well controlled check blood glucose
    
    • should be between 4 and 7
• medical emergencies kit available
  
  • ask volume glucose normally administered
  • ask what normal hypo signs are

Question 15

What should be done if a patient exhibits signs and symptoms of hypoglycaemia in the dental chair?

Answer 15

• stop treatment
• provide glucose tablet
• determine if further intervention is required
• phone ambulance
• buccal hypostop gel if patient can’t swallow
• if unconscious deliver glucagon injection

Question 16

What dose of glucagon should be delivered to a patient in a hypoglycaemic state?

Answer 16

• 1mg
  
  • adult dose
  • suitable for over 8 years old/25kg
• 0.5mg
  
  • paediatric dose
  • suitable for under 8 years old/25kg

Question 17

What considerations must be made for a paediatric patient with diabetes requiring a general anaesthetic?

Answer 17

• liaise with diabetic management team
• ensure well controlled
• managed in hospital due to fasting
  • theatre plan
    
    • food
    • drips
    • insulin
  • first on list
    
    • reduces fasting period
  • endocrinology manage dose