Medical emergencies chapter 16 diabetes related emergencies

Several questions should be asked of all diabetic patients prior to dental treatment including:

-Do you monitor your blood sugar levels? If so how often? -what were your most recent blood sugar values? -how are you feeling? -do you take medication for your diabetes? If so did you take it today? -have you eaten today? If so, when? -are you having problems with your eyes, feet, or legs? -do you see your physician regularly? -do you see an eye doctor yearly? -do you know your average hemoglobin value?

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In a dental practice with 2000 patients how many patients would be unaware that they have the condition of diabetes

1/3

What percentage of patients suffering from diabetic ketoacidosis will have some alteration in mental status ranging from drowsiness to coma

10 to 20%

What is the treatment for a conscious patient suffering from hypoglycemia?

15 to 20 g of some form of sugar, such as table sugar, soda, honey, candy, orange juice, or glucose tablets (2-6) /paste. The airway should be secured, and vital signs should be monitored. Once the glucose has been administered, a positive response should occur within 10 to 15 minutes.

Diabetes Mellitus (dm) Affects approximately how many people in the United States?

15.7 million people

People with diabetes are how many times more likely to have heart disease?

2 to 4 times more likely. They are five times more likely to suffer a stroke, with more than 11,000 deaths each year.

gestational diabetes occurs in approximately what percentage of pregnant women?

2 to 5%

What percent of all cases of diabetic ketoacidosis occur in newly presenting type 1. Diabetes

25%

In a dental practice with 2000 patients approximately ______ patients will have diabetes

40 to 70

What is the percentage of people who suffer from type 1 diabetes?

5 to 10%

What is the mortality rate on diabetic keto acidosis?

5 to 10%. The rate is even higher for elderly patients.

What percentage of diabetics Does diabetic neuropathy affect?

60 to 70% of diabetics

More than ______ % of People with diabetes are diagnosed with type of diabetes 2?

90%

Describe the OGTT

A persons blood glucose level is measured after a fast and Two hours after drinking a glucose rich beverage. If the two hour blood glucose level is between 140 and 199 mg/dL, The person tested has prediabetes. If the two hour blood glucose level is at 200 mg/dL or higher, the person tested has diabetes

What reading indicates that a patient is hyperglycemic?

Above 150

Describe type 1 diabetes

Absolute lack of circulating insulin that results when pancreatic beta cells within the islets of Langerhans have been destroyed because of the immune dysfunction

What is diabetes Mellitus?

Auto immune metabolic disorder characterized by hyperglycemia ( High blood glucose level)

What reading indicates that the patient is hypoglycemic?

Below 50

What is a normal blood glucose reading?

Between 50 and 150 mg/dL

If you don't maintain your diabetes what complications can you get?

Blindness, kidney disease, nerve damage, stroke, and heart disease

How is the diagnosis of diabetes conducted by healthcare provider?

By conducting a fasting plasma glucose test (FPG) or an oral glucose tolerance test (OGTT).

Describe gestational diabetes

Characterized by glucose in tolerance, with initial onset during pregnancy

What is diabetic retinopathy ?

Common sequela of diabetes and one of the leading causes of blindness in individuals from ages 20 to 74 years old

What are signs and symptoms of hypoglycemia?

Confusion seizures coma dizziness weakness syncope headache intense hunger, clammy skin profuse perspiration irritability or aggressive behavior

Describe diabetic nephropathy

Damage to the small blood vessel's in the kidneys, impairing their ability to filter impurities from blood for excretion in the urine. Persons with kidney failure must have a kidney transplant or undergo dialysis to cleanse their blood. Once diabetic renal failure has occurred there is nearly 100% mortality within 10 years

More information on diabetic ketoacidosis

Diabetic ketoacidosis is also common in children on insulin pump therapy since only the short acting type of insulin is used in those pumps. In addition individuals suffering from an infection or prone to diabetic ketoacidosis as their bodies my require additional insulin. alcohol and cocaine have been implicated in the formation of diabetic ketoacidosis and diabetics

Who is usually affected by hyperosmolar hyperglycemic States.

Elderly, infirm, neglected, institutionalized, or mentally challenged diabetic patients who cannot recognize their thirst or express their need for water; therefore it is uncommon, but not impossible, for this condition to be seen in the dental office

What does evidence suggest regarding the placenta and diabetes?

Evidence suggests that the presence of an enzyme in the placenta and consider all destruction of insulin by the placenta play a role in the development of gestational diabetes.

What is insulin?

Hormone that aids in the conversion of sugar and starches to a form that the body can transport to the cells to utilize for energy

Type 1 diabetic's ordinarily take what types of insulin?

Humalog or Novalog. However there are a number of different insulin types. They vary by time of onset, peak effectiveness, effective duration, and maximal duration.

Describe type 2 diabetes

Inability of the body to produce sufficient amount of insulin or to properly use the insulin that is produced

What are oral complications?

Increased incidence of periodontal disease, abscesses, xerostomia, Lichen planus, candidiasis

What is the latest device to treat insulin?

Inhalation device

What is diabetic keto acidosis caused by?

Insufficient insulin levels in the blood. Because of these low levels of insulin, glucose metabolism is an insufficient energy source, and the body shifts to metabolizing fatty acid's for energy. The byproducts of fatty acids when metabolized or Keytone bodies, which causes the blood to become more acidic than usual. And attempt to reverse the acidosis, the body begins to exhale excess carbon dioxide, which results in tachypnea accompanied by an increase depth and respiration. Known as Kussmaul respirations or air hunger. These ketones are excreted in the urine along with sodium and potassium, resulting in a more severe electrolyte disturbance. Even though some key tones are illuminated, more are produced then are excreted, and therefore the acidosis increases, causing various signs and symptoms.

What is a glucometer?

It is a tool that measures the amount of glucose in blood.

If hypoglycemia is prolonged, additional symptoms can occur like?

Lethargy, irritability, confusion, slurred speech, headache and aggressive or bizarre behaviors. This condition may be mistaken for an acute central nervous system event, sepsis, or psychiatric disease

What are common medications to treat type 2 diabetes?

Metformin(Glucophage), tolbutamide (Orinase), And glyburide (Micronase, Diabeta, Glynase). Diagnosed based on the cause of diabetes, as well as the severity of the condition

Describe macrovascular and microvascular complications

Micro angiopathic changes in the capillaries, leading to formation of thrombi and impairment of normal blood flow. The diminished blood flow causes an increased risk of stroke and myocardial infarction of these patients.

Describe gangrene?

Microangiopathic changes in the peripheral arteries often affected the legs and increase the risk of gangrene with the possible sequela of amputation.

Type two diabetes often occurs because of what?

Obesity, high fat low fiber diets, and a sedentary lifestyle.

Describe diabetic neuropathy

Pain in feet and hands, slowed digestion, and other neurological problems are common. There are mild to severe forms Of the nervous system damage.

What is the fourth category for diabetes?

Prediabetes (impaired glucose tolerance for those individuals not yet diagnosed with full-blown diabetes)

Describe diabetic retinopathy

Progresses from the mild form characterized by increased vascular permeability to a more moderate form characterized by vascular closure. The most severe form results and growth of new blood vessels on the retina and the posterior surface of the vitreous. Macular Edema, characterized by retinal thickening from leaky blood vessels, can develop at all stages of retinopathy. Diabetics are also prone to cataracts and glaucoma. Early screening and strict glucose control or essential for preventing diabetic retinopathy.

Diabetes Mellitus Is it condition caused by

Reduction or absence of the production of insulin by the beta cells of the pancreas or defects of insulin receptors

What are some strategies that should be employed when treating a diabetic patient in the dental office?

Scheduling appointments in the early to mid morning hours Keeping appointments short Instructing the patient to continue normal dietary intake before the appointment Checking patient's blood glucose prior to any invasive procedure or if patient complains of feeling unwell Scheduling frequent recall examinations and prophylaxis Using topical fluoride when patients are at risk for caries Recommending saliva substitutes for xerostomia

How often should a diabetic test their blood levels?

Several times a day

What are three medical emergencies from which a diabetic patient may suffer in the dental office?

Severe hypoglycemia or diabetic ketoacidosis (DKA) Hyperosmolar hyperglycemic state, and hypoglycemia

What is the risk of sensitivity using the inhalation route?

Some of the insulin maybe deposited in the mouth and throat rather than the lungs which reduces the amount of medication delivered to the patient

Treatment of diabetic keto acidosis

Step one- determine an accurate blood glucose level The necessary treatment for this patient is to lower blood glucose levels by providing insulin; however, the provision of insulin should be performed by a medical professional as the appropriate dosage is sensual to ensure the patient does not become hypoglycemic. If the clinician is unsure as to which diabetic emergency the patient is experiencing, then it is best to provide some form of glucose as it will not significantly harm a patient experiencing diabetic ketoacidosis and will benefit a patient suffering from severe hypoglycemia. In addition, fluid therapy is needed to reverse dehydration. Vital signs should be monitored to determine the severity of diabetic ketoacidosis

Patients with type one diabetes are dependent on what for survival?

Supplemental insulin

Signs and symptoms of diabetic ketoacidosis

Tachypnea accompanies by an increase depth in respiration (Kussmaul respirations) Alteration in mental status-drowsiness to coma Dehydration Poor skin turgor Warm, dry skin and mucous membranes Increased thirst Muscle weakness Severe fatigue Nausea Vomiting Blurred vision Fruity odor on breath Hypotension Tachycardia

What could happen if the patient with gestational diabetes is left untreated?

The infant may suffer from fetal Macrosomia, hyperglycemia, hypercalcemia, or hyperbilirubenemia

What are the concerns for increase or pancreatic islet cell transplantation? (Aid in controlling blood glucose levels)

The need for continuous immunosuppression to prevent rejection of the Islet cells or pancreas. There has been success with this treatment options though

What is the treatment for unconscious patients who are not able to take an oral carbohydrate?

The treatment of choice is glucagon (1 mg administered subcutaneously, intramuscularly, or intravenously), Which is effective at stimulating hepatic glycogenolysis

What are insulin pumps or continuous infusion therapy? And when were they introduced as a replacement for daily injections?

Their contact devices with an insulin filled syringe or cartridge that is attached to a subcutaneously inserted catheter. The catheter is usually changed every 4 to 6 days. Patients with insulin pumps still need to measure the glucose levels and adhere to a proper nutritional regimen. Data suggests that patients with insulin pumps have better glycemic and metabolic control. 1970s

Where should you store diabetic medications?

They are recommended to be kept refrigerated to lengthen effectiveness

What percentage of diabetics have type 2 diabetes?

They comprise of 90% to 95% of all diabetic patients. Because of an increase in life spans, sedentary lifestyle, and obesity the figure is increasing especially in the adolescent population.

What is hypoglycemia?

This condition used to be referred to as insulin shock, which essentially was severe hypoglycemia with a blood glucose level lower than 40 to 50 mg/dL. Usually occurs because of a missed meal or irregular eating, consumption of alcoholic beverages, or increased exercise without adjusting the insulin dosage. The brain is dependent on a continuous supply of glucose, so brain function is affected when glucose levels fall below a critical level

Describe diabetic ketoacidosis

This is not an emergency that a dental professional would likely encounter; however there is a chance that it would occur. Occurs in a diabetic who is not medicating or eating appropriately; that is why older adults and teenagers, particularly girls who have negative attitudes toward eating, often suffer from this disorder

What is a glycated hemoglobin test?(HbA1c)

This test reveals The patient average blood sugar level over the past 2 to 3 months. I'm testing methods are available, making it easier for patients to monitor their levels.

Diabetics may suffer from delayed wound healing and their risk of secondary oral and systemic infections is increased. True or false?

True

Three types of diabetes

Type 1, type 2and gestational diabetes

What is the process for testing one's own blood sugar?

Use a small Lancette to gain a drop or two of blood from the pad or side of the fingertip. The blood drive is then placed on a test strip, and the strip is inserted into a calibrated glucometer. If you seconds later the glucometer, Will display the patient's blood glucose reading.

After a patient's pregnancy is over that has gestational diabetes, Does the condition go away?

Usually disappears after pregnancy; however in many instances it will return years later.

What is hyperosmolar hyperglycemic state? (Formerly known as hyper osmolar nonketotic syndrome)

When patient is hyperglycemic and dehydrated; however they will not be acidotic.

Describe the fasting plasma glucose test (FPG)

With the FPG test, A fasting blood glucose level (taken after 12 to 14 hour fast). Between 100-125 mg/dL signals prediabetes. Person with a fasting blood glucose level of 126 mg/dL or higher has diabetes

What does the insulin inhalation device use?

You modified nebulizer connected to a special holding chamber that allows a special number of measured puffs to deliver the appropriate amount of insulin. The medication is more rapidly absorbed then injected insulin and avoids the use of needles, which are objectionable to most patients