What is the most common endocrine disorder?
How does Diabetes Mellitus manifest?
Manifested by Hyperglycemia
What is the #1 cause of End Stage Renal Disease?
What is the difference between Type I and Type II diabetes?
What is Gestational Diabetes?
- Reported 2-10% of pregnancies
- 35-60% risk for developing DMII in 10-20 years
What is FPG?
What are normal, pre-diabetic, and diabetic values?
- Fasting Plasma Glucose
- Normal: < 100 mg/dl
- Pre-Diabetes: 100-125 mg/dl
- Diabetes > 126 mg/dl
What OGTT stand for?
What are the Normal, Pre-Diabetes, and Diabetic lab values?
- Oral Glucose Tolerance Test
- Normal: < 140 mg/dl
- Pre-Diabetes: 140-199 mg/dl
- Diabetes: > 200 mg/dl
What are HbA1c lab values for Normal, Pre-Diabetes, and Diabetes?
- Normal: < 5.7%
- Pre-Diabetes: 5.7 - 6.4 %
- Diabetes: > 6.5 %
Describe the Pathogenesis of Type I DM...
- Environmental insult triggers autoimmune reaction
- Microbial, chemical, dietary
- Cell mediated destruction of Beta Cells
Describe the Honeymoon Phase of DM Type I...
- Recovery of beta cell function after start of insulin therapy
- Exogeneous insulin requirements drop
- Insulin secretion will eventually fail
What is the Pathogenesis of Type 2 DM?
- Insulin resistance
- Results in decreased intracellular glucose transporter activity
- Beta cell compensation
- Beta cells gradually fail to compensate for increasing insulin resistance
- Impaired glucose tolerance
- Fasting hyperglycemia
- Eventual beta cell failure
How does one self monitor DM?
- Blood glucose
- Urine glucose
What does HbA1c stand for?
Reflects long term control
Describe a rapid-acting Insulin...
- Onset 15 minutes
- Peak 30 minutes
- Duration: 4-5 hours
Describe a short acting insulin...
- Insulin (Regular)
- Onset: 30-60 minutes
- Peak: 50-120 minutes
- Duration: 5-8 hours
Describe a Intermediate acting Insulin...
- Onset: 1-3 hours
- Peak: 8 hours
- Duration: 20 hours
Describe a Long Acting Insulin...
- Onset: 1 hour
- Peak: N/A
- Duration: 24 hours
What is an Insulin Pump?
- Uses portable infusion pump connected to an indwelling subcutaneous catheter
- Shown to have significant advantages over multiple daily injections
- Reduces glycemic variability, clinical hypoglycemia
What are GLP-1 and GIP?
- Incretin Mimetics
- Mimics naturally occurring gut hormones
- Promotes insulin relase
- Inhibits glucagon release
- Gila monster saliva
What kind of drug is Metformin?
- Anti-hyperglycemic agent
- Decreased HGP (hepatic glucose production)
- Decreased IR (insulin resistance)
- Decreased glucose adsorption
What kind of drug is Arcarbose?
- Oral Anti-diabetic agent
- Glucosidase Inhibitors
- Delays digestion of carbs and adsorption of glucose
What kind of drug is Rosiglitazone?
- Oral anti-diabetic agent
- Decreased Insulin Resistance (IR)
- Decreased Hepatic Glucose Production (HGP)
- Increased glucose disposal
What kind of drug is Januvia?
- Inhibits enzymatic breakdown of GLP-1 and GIP
What do Oral Antidiabetic Agents like Sulfonyureas do?
What are 2 examples?
- Increased pancreatic insulin secretion (chronically)
What is an example of an oral antidiabetic agent that acts acutley?
- Increased pancreatic insulin secretion (acutley)
When should you see a Diabetic patient as a dentist?
- Minimize stress: short, midmorning appointments
- High insulin activity in afternoon
- Increased risk of hypoglycemia
How should a dentist instruct a diabetic patient to eat prior to a dental appointment?
- Patient should take all usualy meds
- Continue usual diet
- Normal procedure dietary intake
If a diabetic pt needs to NPO, how do you manage a clinical encounter?
- May need to alter insulin regimen
- NPO causes...
- Increased physiologic and psychologic stress
- Increased release of epi and corticosteroids
- Induces hyperglycemia
What should you consider if a patient has a HgA1c > 8%?
- Consider antibiotics (High blood sugar is perfect food for microbes)
- Pre-op/post-op finger stick
- Consult physician
What are signs and symptoms of Hypoglycemia (Initial State)?
- Initial State:
What are the signs and symptoms of a patient experiencing a Moderate State of Hypoglycemia?
What are the signs and symptoms of someone in a severe state of Hypoglycemia?
How do you treat Hypoglycemia?