Pharm Chp 18 Patients with Diabetes

Which would be the most appropriate action if the diabetic dental patient is having an adverse reaction and the dental professional is unable to distinguish if it is an insulin reaction (hypoglycemia) or hyperglycemia?

-Give small amounts of sugar orally to the conscious patient. Because distinguishing hypoglycemia (low glucose) from hyperglycemia (high glucose) is often difficult, the best course of action is to give the patient a small amount of sugar, which will effectively treat hypoglycemia and will produce little additional harm if hyperglycemia is present. Insulin should not be administered in a dental office emergency; the patient should be taken to a hospital emergency room immediately. Hypoglycemia is a far more common diabetic emergency. If the patient does not respond to the small amount of sugar, activate emergency medical services, and wait for their arrival.

Insulin can be only be used to treat Type I diabetes. Oral antidiabetic agents are used for both Type I and Type II diabetes.

Both statements are false. Insulin is the only treatment for type 1 diabetes, and is often used in patients with type 2 diabetes. There are currently 10 groups of oral agents used to treat diabetes, known as oral antidiabetics. These drugs are only used to treat type 2 diabetes.

Insulins vary widely in their chemical formulation. The two formulations of human insulin vary slightly from insulin secreted by healthy persons.

Both statements are false. The major differences between the currently used types of insulin are their onset and their duration of action. Although insulin was prepared from beef or pork pancreases in the past, human insulin is now used exclusively. Two processes are used to produce human insulin: synthesizing recombinant deoxyribonucleic acid and modifying porcine (pork) insulin. Both of the resulting compounds are identical to the insulin secreted by humans.

Which is the most accurate measure of the patients' glucose control?

Glycosylated hemoglobin Although serum glucose and urinanalysis can give indicators of glucose control, they are not the best reflections of the patient's overall glucose control. The glycosylated hemoglobin reflects the glucose control over a 2- to 3-month period; thus, it more accurately measures the patient's overall serum glucose control.

What is the most common adverse reaction associated with insulin?

Hypoglycemic reaction The most common adverse reaction associated with insulin is hypoglycemic reactions. Patients can unintentionally overdose on insulin, fail to eat or not eat enough to balance out the insulin, increase their exercise or stress level, or suffer from an infection. Hypoglycemic reactions can happen quickly. Hyperglycemic reactions occur over a longer time period, and the patient usually feels unwell. Allergic reactions to insulin may occur, but they are not the most commonly insulin adverse reaction. Idiosyncratic reactions are unpredictable and do not commonly occur.

All are oral antidiabetic agents except:

Oral insulin No oral insulin formulations have been developed. Insulin is usually administered by subcutaneous injection due to its large molecular size, which prevents absorption from the gastrointestinal tract. Classes of oral antidiabetic agents include sulfonylureas, biguanides, meglitinides, thiazolidinediones, dipeptidyl-peptidase-4 inhibitors, α-glucosidase inhibitors, glucagon-like peptide-1 receptor agonists, bile acid sequestrants, pramlintide (Symlin), and the sodium glucose transporter-2 inhibitors.

Diabetic neuropathy can affect the oral cavity by causing pain and burn of the tongue and other oral structures. Amitriptyline, carbamazepine, phenytoin, and metoclopramide are used to manage the symptoms.

The first statement is true; the second statement is false. Diabetic neuropathy can affect the oral cavity by causing pain and burn of the tongue and other oral structures. Amitriptyline, carbamazepine, phenytoin, and capsaicin are used to manage the pain and burning connected with diabetic neuropathy. The neurologic problems of diabetes can cause the gastrointestinal tract to lose muscle tone (atony or diabetic gastroparesis). Metoclopramide is used to treat this condition.

Which drugs may change insulin requirements and should be used with caution?

a and c only Epinephrine, glucocorticoids, and opioid analgesics should be used with caution in diabetic patients because these drugs can increase or decrease insulin requirements. Caution should also be used with general anesthesia due to the possibility of acidosis. Large doses of salicylates should be avoided, because they could induce hypoglycemia.

Patients with uncontrolled diabetes have increased susceptibility to which oral conditions?

a, b, and d Uncontrolled diabetes can have multiple adverse effects on the oral cavity, including increased susceptibility to dental caries, xerostomia leading to mucositis, ulcers, infections, and inflammed tongue, and increased risk of periodontal disease. Patients with uncontrolled diabetes mellitis are are higher risk for xerostomia, related to fluid loss secondary to increased urination. Lack of protective salivary lubrication, buffering, and antimicrobial properties leads to increased risk of caries, oral infections, and periodontal disease. Attrition due to bruxism is not linked to uncontrolled diabetes mellitus. It is important to note that the periodontal status of the patient with well-controlled diabetes is controversial.

Which special considerations should be made to manage dental appointments for patients with diabetes?

b, c, e Dental appointments for diabetics should not interfere with meals and should involve minimal stress. If the diabetes is under control, oral surgery should be performed within 2 hours of a normal breakfast and medications. Other management considerations include questioning the patient about the last meal ingested to avoid hypoglycemia, monitoring infection closely due to delayed healing time, avoiding large doses of salicylates (which could induce hypoglycemia), providing a quick glucose source for hypoglycemia, checking for oral complications related to diabetes, and asking the patient about the results of blood glucose monitoring.