Dental Management Ch. 14 Diabetes Mellitus

For most patients with diabetes, routine use of local anesthetic with

1 : 100,000 epinephrine is well tolerated.

The A1C reflects glucose levels in the blood over the preceding

3 months, which is the approximate life span of a red blood cell

Regular insulin is given how long before a meal

30 to 45 min

A positive family history of type 2 diabetes confers a lifetime risk of

38% to the offspring if one parent is affected and 60% if both parents are affected

Diabetes mellitus decreases life expectancy by

5 to 10 years

Gestational diabetes mellitus occurs in

5% to 7% of pregnant women during pregnancy

In well-controlled diabetes, the HbA1c level should stay below

7%, without the occurrence of clinically significant hypoglycemia

What causes ketoacidosis

Being diabetic -sepsis -GI bleed -MI infarction -infection

FPG levels

Fasting Plasma Glucose levels

Short-acting insulin are injected how soon before a meal?

Just before (less than 10 min) or just after a meal

Biguanides

Metformin Insulin sensitizer, acting on the liver or peripheral tissues

What is the leading cause of death in type 1 diabetes patients?

Renal failure

A1C assay

This assay measures the amount of sugar attached to hemoglobin; levels increase in the presence of hyperglycemia.

Retinopathy and nephropathy are eventual complications in nearly every person with

chronic diabetes

Continuous subcutaneous insulin infusion

continuous injection of insulin into the blood from a pump inserted under the skin

Kidney complications of Diabetes

diabetic nephropathy

ketoacidosis

excessive production of ketones, making the blood acidic

Sulfonylureas

glyburide stimulate insulin secretion by interacting with ATP-sensitive potassium channel on the beta cell

The primary diagnostic criterion for diabetes is FPG levels of

greater than 126 mg/dL on more than one occasion

Diabetes mellitus is a group of metabolic diseases characterized by

high blood glucose levels (hyperglycemia) and the inability to produce and/or use insulin.

What genetic component is linked to type 1 diabetes?

human leukocyte antigen genes on chromosome 6

2 types of prediabetes

impaired glucose tolerance and impaired fasting glucose

Glinides

increase the secretion of insulin in the presence of glucose

Hyperglycemia leads to glucose excretion in the urine, which results in

increased urinary volume

Type 2 diabetes is characterized by i

insulin resistance and relative insulin deficiency

Metabolic disturbances of diabetes mellitus

ketoacidosis and hyperosmolar nonketotic coma (type 2 DM)

Type 1 diabetes is primarily the result of pancreatic beta cell destruction and is characterized by

lack of insulin

Persistent hyperglycemia leads to

metabolic and vascular complications.

Vascular complications of diabetes mellitus are due to

microangiopathy and atherosclerosis

myopia

nearsightedness

incretins

peptides that are produced in the GI tract in response to food that help to modulate insulin and glucagon activity

cardinal manifestations of diabetes type 2

polydipsia, polyuria, polyphagia, weight loss, loss of strength

Signs and symptoms of type 1 DM include

polydipsia, polyuria, polyphagia, weight loss, loss of strength, marked irritability, recurrence of bed wetting, drowsiness, malaise, and blurred vision

The decision to use antibiotic prophylaxis or coverage typically involves consultation with the patient's physician and is related to

poor glycemic control.

Eye complications of diabetes mellitus

retinopathy, cataracts, new cases of blindness

Aspirin and nonsteroidal antiinflammatory drugs can potentially enhance the efficacy of some oral hypoglycemic agents (sulfonylureas) and enhance hypoglycemia; thus,

they should be used judiciously

Autoantibodies against beta cell constituents are present in 85% to 90% of patients with

type 1 diabetes, and destruction of beta cells is modulated by T cells

Basal insulin

type of insulin that controls glucose production between meals and overnight, is about 50% of daily needs, nearly constant levels

Signs and symptoms of type 2 DM are

typically insidious and the cardinal manifestations are less commonly seen

Complications of extremities in DM

ulceration and gangrene of feet Is leading cause of non-accident-related leg and foot amputations

Patients with diabetes undergoing dental treatment may not be diagnosed and may be at risk for complications such as

unconsciousness, infection, bleeding, drug interactions, and side effects.

Oral complications of poorly controlled diabetes mellitus may include

xerostomia; bacterial, viral, and fungal infections (including candidiasis); poor wound healing; increased incidence and severity of caries; gingivitis and periodontal disease; periapical abscesses; and burning mouth symptoms