Diabetes Mellitus

Question 1

pathophysiology of diabetes mellitus

Answer 1

• metabolic disease
• inability to produce and/or use insulin
• slectively damages a certain subset of cell types

Question 2

pts with DM are hyperglycemic or hypoglycemic?

Answer 2

hyperglycemic (high blood glucose levels)

Question 3

which subset of cell types cannot tolerate or regulate in a hyperglycemic state and are damaged?

Answer 3

1. capillary endothelia cells in retina
2. mesangial cells in glomerulus
3. neurons and Schwann cells in brain

Question 4

what are some independent accelerating factors that will pre-dispose ppl for certain complications of DM?

Answer 4

• hypertension

- hyperlipidemia

Question 5

what are the type types of DM?

Answer 5

• Type 1

- Type 2

Question 6

Type 1 DM

Answer 6

insulin deficiency secondary to autoimmune destruction of pancreatic beta cells

Question 7

Type 2 DM

Answer 7

insulin resistance secondary to genetic, environmental and aging factors

Question 8

what is the most common type of diabetes?

Answer 8

Type 2

Question 9

systemic complications of diabetes

Answer 9

• retinopathy
• cerebrovascular disease
• coronary heart disease
• nephropathy
• peripheral vascular disease
• neuropathy
• ulceration and amputation

Question 10

diabetes leads to what CV effects?

Answer 10

accelerated atherosclerosis (CAD)

Question 11

risk of stroke and CAD death is how many times higher in diabetics?

Answer 11

2-4x

Question 12

what is the leading cause of death in type 2 diabetics?

Answer 12

MI

Question 13

diabetics are 25x more likely to acquire what than those without diabetes?

Answer 13

end-stage renal disease (ESRD)

Question 14

what is the leading cause of death in type 1 diabetics?

Answer 14

ESRD

Question 15

HbA1C

Answer 15

• tests amount of sugar attached to hemoglobin

- monitors pt’s progress

Question 16

what does an HbA1C indicate?

Answer 16

glycemic level over last 2-3 months

Question 17

how often do controlled diabetics have to get their HbA1C drawn?

Answer 17

2x/yr

Question 18

how often do uncontrolled diabetics have to get their HbA1C drawn?

Answer 18

4x/yr

Question 19

HbA1C for non-diabetics

Answer 19

<6%

Question 20

HbA1C for well-controlled diabetics

Answer 20

<7%

Question 21

T/F: systemic complications increase with increasing A1C

Answer 21

true

Question 22

pts with <7% A1c have what percent of fewer systemic complications?

Answer 22

42%

Question 23

pts with <7% A1c have what percent of fewer deaths than those with >8% A1c?

Answer 23

57%

Question 24

what is the goal of monitoring pt’s A1c?

Answer 24

strict glycemic control

Question 25

general medical management of diabetics

Answer 25

- modified nutrient intake - physical activity recommendations - oral hypoglycemics, insulin injections, or insulin pump - blood pressure control - favorable lipid profile - management of CV, renal, and ocular involvement

Question 26

med management of type 1 diabetics

Answer 26

- injectable insulin-subcutaneous - combo of long and short-acting agents - multiple dosing throughout day

Question 27

long-acting agents mimic what?

Answer 27

normal basal secretion

Question 28

short-acting agents mimic what?

Answer 28

meal-time secretion

Question 29

external insulin pumps

Answer 29

- for pts who are not compliant - catheter in abdominal wall - constant basal infusion, pt boluses at meals

Question 30

med management of type 2 diabetics

Answer 30

- lifestyle mods - control risk factors for CV disease - drug therapy

Question 31

how can you manage risk factors for CV disease in type 2 diabetics?

Answer 31

- BP & lipid control | - ASA for antiplatelet therapy (to decrease risk for developing clots)

Question 32

drug therapy for type 2 diabetics

Answer 32

- 1 or more hypoglycemics | - +/- injectables

Question 33

dental txtment for controlled diabetics

Answer 33

- any elective care is okay (surgery is fine too) - prevention of problems secondary to oral hypoglycemics or insulin - check glucose prior to starting txtment

Question 34

dental txtment concerns with uncontrolled diabetics

Answer 34

- infection - poor wound healing - systemic risk

Question 35

how do you txt an uncontrolled diabetic with a hot tooth?

Answer 35

- aggressive management | - strict glycemic control

Question 36

should you perform elective surgery on pts with uncontrolled diabetes?

Answer 36

no

Question 37

what systemic risks are uncontrolled diabetics at risk for?

Answer 37

- HTN - CAD - stroke

Question 38

acute odontogenic infection in diabetics

Answer 38

- infection can lead to loss of diabetic control | - loss of diabetic control can lead to aggressive infection

Question 39

are you more concerned about an acute odontogenic infection in what type of diabetics?

Answer 39

- uncontrolled and brittle diabetics | - type 1 diabetics on high insulin dosages

Question 40

goal of management of acute infection

Answer 40

cure infection and restore glycemic control

Question 41

how can you treat an acute odontogenic infection in uncontrolled diabetics?

Answer 41

- ext - incision and drainage - antibiotics

Question 42

hypoglycemia secondary to too much insulin or too little food is considered what?

Answer 42

an emergency

Question 43

what are the 3 clinical stages of hypoglycemia secondary to too much insulin or too little food?

Answer 43

1. mild 2. moderate 3. severe

Question 44

mild clinical stage of hypoglycemia secondary to too much insulin or too little food

Answer 44

- hunger - weakness - sweating - tachycardia

Question 45

moderate clinical stage of hypoglycemia secondary to too much insulin or too little food

Answer 45

- incoherent - uncooperative - belligerent - disorientation

Question 46

severe clinical stage of hypoglycemia secondary to too much insulin or too little food

Answer 46

- unconscious - hypotensive - tachycardia

Question 47

txtment of insulin rxn in conscious pts

Answer 47

- give oral sugar | - should be better within 5 minutes

Question 48

txtment of insulin rxn in unconscious pts

Answer 48

- EMS - glucagon injection - BLS prn

Question 49

normal blood glucose

Answer 49

between 70-200

Question 50

how can you prevent insulin shock in diabetic pts?

Answer 50

1. instruct pts to follow normal insulin regimen and eat normally around appt 2. morning appt 3. confirm they ate and took insulin/hypoglycemics 4. instruct pts to notify you ofsyms during the office visit 5. source of sugar in the office