Ch. 44 - Diabetes Mellitus

Q. The safe blood glucose level necessary for unaltered dental hygiene care is _____ mg/dL. A. <70 B. 80 to 150 C. 150 to 240 D. >240

80 to 150 Feedback The safe blood glucose level necessary for unaltered dental hygiene care is 80 to 150 mg/dL. Emergency situations are possible when blood glucose levels are <70 mg/dL and >240 mg/dL. Patients with blood glucose values in the range of 150 to 240 mg/dL should be treated carefully and monitored for complications related to diabetes.

Q. What percentage of people with diabetes have severe periodontal disease? A. 25% B. 33% C. 50% D. 75%

33% Feedback Diabetes is associated with increased incidence of periodontal disease. One-third of people with diabetes have severe levels of periodontal bone destruction. In fact, people with diabetes are twice as likely to develop periodontal diseases as those without diabetes.

Q. What percentage of persons with type 2 diabetes take insulin to treat the condition? A. 10% B. 20% C. 30% D. 40%

40% Feedback: Approximately 40% of persons with type 2 diabetes take insulin to treat hyperglycemia. Approximately 10% use insulin and oral medications to treat type 2 diabetes.

Q. What mechanism is thought to cause tissue damage in persons with diabetes? A. Alteration of the immunoinflammatory response B. Bacteriologic overgrowth C. Ketoacidosis D. Hypoglycemia

Alteration of the immunoinflammatory response Feedback The mechanism thought to cause tissue damage in persons with diabetes (periodontal disease) is alteration of the immunoinflammatory response, specifically increased cytokines and altered chemotaxis and phagocytosis of neutrophils. Although bacteria are necessary for periodontal diseases to occur, there is very little difference in the bacteria of persons with and persons without diabetes. Ketoacidosis is the result of the body's breakdown of fats and proteins; it increases acid in the blood, and it does not cause periodontal inflammation. Hyperglycemia (high blood glucose levels) is the trigger for the mechanism that causes tissue damage. Furthermore, increased cytokines are found with increased hyperglycemia. However, the term hypoglycemia means a low blood glucose level.

Q. A scheduled client has diabetes and is showing symptoms of diabetes. The client reported recent test findings of a fasting blood glucose level >126 mg/dL, and blood glucose levels >200 mg/dL 2 hours after a meal. The dental hygienist should do which of the following? A. Defer treatment and refer client to his physician. B. Conduct a consultation with the physician to determine the best course of action. C. Continue dental hygiene care. D. Let the dentist provide the periodontal maintenance care.

Defer treatment and refer client to his physician. Feedback After assessing a person with symptoms of diabetes, fasting blood glucose levels of 126 mg/dL or higher, and blood glucose levels over 200 mg/dL 2 hours after a meal, the dental hygienist should defer treatment and refer the client to their physician. These values reflect a diagnosis of diabetes, and the person will benefit from the referral. Furthermore, continuing care without alterations may result in complications from the dental care (such as infection and poor healing). A consultation with the physician to determine the best course of action will most likely result in the same course of action—specifically, referral. The diabetes needs to be controlled before dental hygiene care.

Q. How frequently should persons with diabetes monitor their blood glucose levels? A. Every 6 months at the physician's office B. Four times a day C. Once every 3 months D. Only when fasting

Four times a day Feedback It is recommended that diabetic patients test their blood glucose levels at least four times a day. The physician will routinely test blood glucose during an office visit as well as drawing blood for the A1c laboratory test once every 3 months. With self-monitoring, the first blood glucose test of the day is called a fasting blood glucose test.

Q. Glucose intolerance that can occur during pregnancy is termed: A. Impaired fasting glucose B. Gestational diabetes mellitus C. Prediabetes D. Autoimmune diabetes

Gestational diabetes mellitus Feedback Gestational diabetes mellitus causes glucose intolerance that is evident during pregnancy. Tests for glucose in the blood will result in various blood glucose levels. Diabetes, prediabetes, gestational diabetes, and impaired fasting glucose (IFG) all have specific diagnostic criteria regarding levels of glucose in the blood. Type 1 diabetes can be referred to as autoimmune diabetes because the cause is thought to be immune destruction of the insulin-producing beta cells in the pancreas.

Q. What emergency care should be given to a conscious client with hypoglycemia? A. Spirits of ammonia B. Epinephrine C. Hard candy D. Glucagon

Hard candy Feedback The conscious patient with hypoglycemia should be given a source of glucose. Hard candy is an option; 4 oz of orange juice is another option. During hypoglycemia and a loss of consciousness, glucagon is administered with an intramuscular injection. Spirits of ammonia can be used as a respiratory stimulant during syncope, but these will not be effective during a diabetic emergency. Epinephrine is used in allergic reactions.

Q. What emergency care should be given to a client with signs and symptoms of hyperglycemia and ketoacidosis? A. Four ounces of orange juice B. Oxygen C. Glucose tablets D. Hospitalization

Hospitalization Feedback A patient with signs and symptoms of hyperglycemia and ketoacidosis should be transported to a hospital to receive intravenous fluids and electrolyte replacement. Hypoglycemia can be treated with 4 oz of orange juice if the patient is conscious. Oxygen is generally reserved for emergencies involving respiratory distress where the patient is breathing.

Q. The six complications of diabetes are caused by which of the following? A. Medications B. Absence of insulin C. Lack of glucose to the brain D. Hyperglycemia

Hyperglycemia Feedback The complications of diabetes include retinopathy, nephropathy, neuropathy, macrovascular diseases, and altered wound healing and are caused by hyperglycemia or elevated blood glucose levels. The oral medications and insulin work to lower blood glucose and improve glycemic control, which decrease the risk of complications. A person with diabetes who experiences low blood glucose or hypoglycemia will have a lack of glucose to the brain. The effects of hypoglycemia will result in confusion, irritability, and slurred speech.

Q. What is the most common medical emergency for people with diabetes? A. Myocardial infarction B. Coma C. Hypoglycemia D. Stroke

Hypoglycemia Feedback Hypoglycemia is low blood sugar and is the most common emergency for people with diabetes. Hypoglycemia can quickly result from increased activity, missing a meal, or increased medications, all of which may be associated with getting to a dental appointment. Heart disease (influencing the occurrence of myocardial infarction and stroke) is a risk for people with diabetes. Therefore the dental hygienist should question the diabetic client about signs of heart disease and should carefully check vital signs. Hyperglycemic ketoacidosis results in a coma. This emergency is less common because it takes several days of very high blood sugar with various other symptoms before a coma results.

Q. When a person with diabetes displays signs of confusion, sweating, irritability, and tachycardia, the medical emergency is most likely to be: A. Myocardial infarction B. Hyperglycemia C. Hypoglycemia D. Convulsions

Hypoglycemia Feedback When a diabetic patient shows signs of confusion, sweating, irritability, and tachycardia, he or she is experiencing low blood sugar or hypoglycemia. Hyperglycemia is more difficult to recognize and is impossible to treat in a dental office. The client experiencing hyperglycemia should go to the hospital for treatment. Convulsions are seen in the advanced stages of both hypoglycemia and hyperglycemia. The signs of myocardial infarction (heart attack) include pain in the chest or feelings of indigestion.

Q. Xerostomia in people with diabetes is due to which of the following? A. Increased fluid loss B. Polydipsia C. Neuropathy D. Parotid gland swelling

Increased fluid loss Feedback Xerostomia in people with diabetes is due to increased fluid loss (dehydration) that results from glucosuria during periods of hyperglycemia. Polydipsia means increased thirst, which is also due to glucosuria and dehydration. In addition, parotid gland swelling is also caused by increased fluid loss. However, neuropathy is nerve pathology that results from hyperglycemia.

Q. A common complication of diabetes, cardiovascular disease, is a result of which of the following? A. Microvascular and macrovascular changes B. Peripheral neuropathy C. Retinopathy D. Nephropathy

Microvascular and macrovascular changes Feedback Cardiovascular disease is a common complication of diabetes resulting from microvascular (pathology of the small blood vessels in the hands and feet) and macrovascular changes (atherosclerosis or hardening of the arteries). Peripheral neuropathy is disease of the nerves in the extremities causing pain and tingling. Retinopathy is a loss of vision caused by pathology of the small blood vessels in the retina of the eye. Nephropathy is kidney disease caused by pathology of the small blood vessels in the kidneys, which can lead to kidney failure.

Q. What is responsible for the increasing incidence of diabetes in the U.S. population? A. Obesity B. Heredity C. Sugar in the diet D. Hypertension

Obesity Feedback The cause for the increasing incidence of diabetes in the American population is obesity. Obesity itself causes some degree of insulin resistance. The other selections include considerations that increase a person's risk for developing diabetes. Heredity (family history of diabetes and ethnic background) is a risk factor in the development of diabetes. Nutritional choices can prevent diabetes, but sugar in the diet is not a cause of diabetes in and of itself. Hypertension increases the risk for developing diabetes.

Q. Which of the following oral conditions is considered the sixth complication of diabetes? A. Dental caries B. Fungal infections C. Xerostomia D. Periodontal disease

Periodontal disease Feedback The American Academy of Periodontology has called periodontal disease the sixth complication of diabetes, adding it to the classic list that includes retinopathy, nephropathy, neuropathy, macrovascular diseases, and altered wound healing. Dental caries, oral fungal infections, and xerostomia are frequent oral problems found in persons with diabetes.

Q. Dietary control of obesity, treatment of hypertension, treatment of hyperlipidemia, and elimination of smoking may do which of the following? A. Prevent dental caries in persons with diabetes. B. Increase gestational diabetes mellitus. C. Prevent prediabetes from becoming diabetes mellitus. D. Prevent oral fungal infections.

Prevent prediabetes from becoming diabetes mellitus. Feedback Dietary control of obesity, treatment of hypertension, treatment of hyperlipidemia, and elimination of smoking may prevent prediabetes from becoming diabetes mellitus. Dental caries in persons with diabetes is prevented with all the same treatment interventions used in persons without diabetes. Gestational diabetes mellitus can be prevented in some women with physical activity and careful nutritional choices; however, other women require special diets, blood glucose monitoring, and insulin injections.

Q. All of the following are drug therapies for people with diabetes. Which one stimulates the pancreas to secrete more insulin? A. Exenatide (Byetta) B. Sulfonylureas C. Alpha-glucosidase inhibitors (Precose) D. Thiazolidinedione (Avandia)

Sulfonylureas Feedback Sulfonylureas are oral hypoglycemic drugs that stimulate the pancreas to secrete more insulin in type 2 diabetes. These were the first drugs used to manage type 2 diabetes. Glyburide is the most commonly used sulfonylurea. Exenatide (Byetta) is the first in a new class of drugs used as an alternative to starting a person with type 2 diabetes on insulin. It increases the response of insulin to glucose. Alpha-glucosidase inhibitors (Precose) slow carbohydrate metabolism in the intestine to prevent high blood glucose after a meal. Thiazolidinedione (Avandia) makes the body tissues more sensitive to insulin.

Q. Polydipsia is the term that describes excessive: A. Urination B. Hunger or eating C. Thirst D. Glucose in the blood

Thirst Feedback Polydipsia is the term that describes excessive thirst. Excessive urination is polyuria. Polyphagia is excessive hunger or eating, and excessive glucose in the blood is hyperglycemia.

Q. Neuropathy, xerostomia, and candidiasis in the person with diabetes may lead to which of the following? A. Dental caries B. Severe periodontal disease C. Tongue changes D. Hyperglycemia

Tongue changes Feedback Neuropathy, xerostomia, and candidiasis are oral conditions frequently seen in people with diabetes who have hyperglycemia. Neuropathy, xerostomia, and candidiasis cause tongue changes in people with diabetes. Dental caries in the patient with diabetes are the result of frequent eating, xerostomia, and glucose content in the saliva. Severe periodontal disease is due to small blood vessel pathology and defects in the immune response. Hyperglycemia is the cause of all these oral conditions in persons with diabetes, not the effect.

Q. A person with prediabetes can prevent the onset of diabetes. A. True B. False

True Feedback A person with prediabetes can prevent the onset of diabetes through weight loss, good nutrition, and physical activity.

Q. Which type of diabetes involves an absolute deficiency in insulin secretion? A. Type 1 B. Type 2

Type 1 Feedback Type 1 diabetes involves an absolute deficiency in insulin secretion. In other words, the pancreas makes no insulin at all. In the case of type 2 diabetes, insulin resistance, relative insulin deficiency, and an insulin secretion defect may all be involved.

Q. Atherosclerotic disease is more common in which type of diabetes? A. Type 1 B. Type 2 C. Gestational diabetes mellitus D. Prediabetes

Type 2 Feedback Atherosclerotic disease is more common in type 2 diabetes, and kidney disease and eye disease are more common in persons with type 1 diabetes.

Q. What is the most common type of diabetes mellitus? A. Type 1 B. Type 2 C. Gestational diabetes D. Prediabetes

Type 2 Feedback In the United States, 23.6 million people have diabetes. Approximately 90% to 95% of persons with diabetes have type 2 diabetes, whereas 5% to 10 % of persons with diabetes have type 1 diabetes. Approximately 6.2 million people have diabetes and have not been diagnosed. These people have diabetes, not prediabetes. Prediabetes is a condition in which a person's blood glucose levels are elevated but are not high enough for a diagnosis of type 2 diabetes. Prediabetes affects approximately 57 million people in the United States. Of women who are pregnant, approximately 4% will develop gestational diabetes.

Q. Which type of diabetes results from insulin resistance and a defect in insulin secretion? A. Type 1 B. Type 2

Type 2 Feedback Type 2 diabetes involves insulin resistance, relative lack of insulin, and a defect in insulin secretion. Type 1 diabetes results when the pancreas completely stops producing insulin.