Chapter 16

Question 1

True or False

Type II diabetes often occurs because of obesity, high-fat-low-fiber diets, and a sedentary lifestyle.

Answer 1

True

Question 2

What is insulin?

Answer 2

The 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.

Question 3

True or False

Diabetes mellitus is an autoimmune metabolic disorder characterized by hyperglycemia (high blood glucose levels)

Answer 3

True

Question 4

What are the three types of diabetes mellitus?

Answer 4

Type 1
Type 2
Gestational diabetes

Question 5

What are the characteristics of Type I diabetes?

Answer 5

Absolute lack of circulating insulin
Patients dependent on supplemental insulin for survival
5-10% of all diabetes

Question 6

What are the characteristics of Type II diabetes?

Answer 6

Inability of the body to produce sufficient amount of insulin or to properly use the insulin that is produced
Managed by diet, oral medications, or injectable medications
90-95% of all diabetes

Question 7

What are the characteristics of gestational diabetes?

Answer 7

Occurs in 2-5% of pregnant women
characterized by glucose intolerance, with initial onset during pregnancy
If left untreated can cause significant developmental disturbances to fetus

Question 8

True or False

A person with a fasting blood glucose level of 126 mg/dL or higher has diabetes

Answer 8

True

Question 9

What are some systemic complications of diabetes mellitus?

Answer 9

Diabetic retinopathy
Macrovascular and microvascular complications
Diabetic neuropathy
Diabetic nephropathy
Oral complications

Question 10

What is diabetic retinopathy?

Answer 10

Disease of the retina of the eye resulting from changes in the blood vessels
Leading cause of blindness in individuals age 20-74

Question 11

What are macrovascular and microvascular complications?

Answer 11

Microangiopathic changes in the capillaries, leading to formation of thrombi and impairment of normal blood flow
Can lead to cerebrovascular accident or myocardial infarction

Question 12

What is diabetic neuropathy?

Answer 12

Impaired sensation in hands or feet, slowed digestion, carpel tunnel syndrome, other neurological problems

Question 13

What is diabetic nephropathy?

Answer 13

Damage to the small blood vessels in the kidneys, leading to impairment in function

Question 14

What are oral complications?

Answer 14

Increased incidence of periodontal disease, abscesses, xerostomia, lichen plans, candidiasis, impaired wound healing

Question 15

True or False

Once diabetic renal failure has occurred, there is nearly 10% morbidity within 10 years.

Answer 15

True

Question 16

What is a good way to avoid oral manifestations?

Answer 16

Maintaining optimal glucose levels

Question 17

What is a normal blood glucose reading?

Answer 17

Between 50 and 150 mG/dL
Reading below 50: hypoglycemic
Reading above 150: hyperglycemic

Question 18

What is the glycated hemoglobin test (HbA1c)?

Answer 18

Test reveals the patient’s “average” blood sugar level over the past two to three months

Question 19

What is the medication recommended for use of patients with type I diabetes?

Answer 19

Insulin (Humalog or Novolog)

Question 20

What are some medications recommended for the use of patients with type II diabetes?

Answer 20

Metformin (Glucophage)
Tolbutamide (Orinase)
Glyburide (Micronase, Diabeta, Glynase)

Question 21

True or False

Pancreas or pancreatic islet cell transplantation is another option for some diabetic patients to aid in controlling blood glucose levels.

Answer 21

True

Question 22

What are some strategies that can be used by the dental professional when treating a diabetic patient?

Answer 22

Scheduling appointments in the early to mid-morning hours
Keeping appointments short
Instructing the patient to continue normal dietary intake before appointment
Checking patient’s blood glucose prior to any invasive procedure
Using topical fluoride when patients are at risk for caries
Recommending saliva substitutes for xerostomia

Question 23

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

Answer 23

Severe hyperglycemia (diabetic ketoacidosis)
Hyperosmolar hyperglycemic state
Hypoglycemia

Question 24

True or False

25% of all cases of DKA (diabetic ketoacidosis) occur in newly presenting type I diabetes

Answer 24

True

Question 25

What is diabetic ketoacidosis?

Answer 25

caused by insufficient insulin levels in the blood, which causes the body to shift towards metabolizing fatty acids for energy, causing blood to become more acidic than usual

Question 26

What are some signs and symptoms of DKA?

Answer 26

``` Tachypnea accompanied by an increased depth in 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 ```

Question 27

True or False In children, a common complication of DKA is cerebral edema which has a high mortality and morbidity rate; therefore, appropriate and swift treatment of the condition is essential.

Answer 27

True

Question 28

What are some steps in the treatment of DKA?

Answer 28

Determine accurate blood glucose level (using glucometer) Fluid therapy Insulin (done by medical professional) Monitor vital signs

Question 29

What is hyperosmolar hyperglycemic state?

Answer 29

Patients will be hyperglycemic and dehydrated Occurs in elderly, neglected, institutionalized, or mentally challenge Cannot recognize their own thirst or express their need for water

Question 30

What are some signs and symptoms of hypoglycemia?

Answer 30

``` Confusion Seizures Coma Dizziness Weakness Syncope Headache Intense hunger Cold, clammy skin Profuse perspiration Irritability or aggressive behavior ```

Question 31

True or False Hypoglycemia occurs when a blood glucose level is lower than 40-50 mg/dL

Answer 31

True

Question 32

What is the treatment for a patient suffering from hypoglycemia?

Answer 32

15-20 gm of some form of sugar (table sugar, honey, candy, orange juice, glucose tablets) Vital signs monitored Unconscious: glucagon

Question 33

An absolute lack of circulating insulin is characteristic of which condition?

Answer 33

Type I diabetes

Question 34

A result of 115 mg/dL on a fasting plasma glucose test would indicate

Answer 34

Prediabetes

Question 35

What causes the gangrene that is often associated with diabetic patients?

Answer 35

Microangiopathic changes

Question 36

All of the following are oral complications associated with diabetes except one. Which one is the exception?

Answer 36

Squamous cell carcinoma

Question 37

Which diabetic emergency is associated with the following symptoms: tachypnea, Kussmaul's breathing, nausea, blurred vision, fruity odor on the breath?

Answer 37

Diabetic ketoacidosis

Question 38

What is the needed treatment for the emergency in the condition cited in question 5?

Answer 38

Administration of insulin

Question 39

The test used to measure a diabetic's average glucose level over the past three months is

Answer 39

HbA1c test

Question 40

All of the following are symptoms of hypoglycemia in a diabetic patient except one. Which is the exception?

Answer 40

Cyanosis

Question 41

What is the diabetic emergency that is often seen in institutionalized individuals?

Answer 41

Hyperosmolar hyperglycemic state

Question 42

All of the following are medications often prescribed for type 2 diabetes except one. Which one is the exception?

Answer 42

Glucagon