1 / 13

Diabetes

Diabetes. Claire Nowlan Nov 28, 2003. Type 1 10% of diabetics Age of onset – young Severe Requires insulin Normal build Little genetic component. Type 2 90% of diabetics Age of onset – 40+ Mild May require insulin, usually hypoglycemics Obese Strong genetic component.

shanae
Download Presentation

Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Diabetes Claire Nowlan Nov 28, 2003

  2. Type 1 10% of diabetics Age of onset – young Severe Requires insulin Normal build Little genetic component Type 2 90% of diabetics Age of onset – 40+ Mild May require insulin, usually hypoglycemics Obese Strong genetic component Comparison of type 1 and 2 diabetes

  3. Pathophysiology • Type 1 diabetes – beta cells are destroyed, eventually no insulin is produced • Type 2 diabetes – insulin secretion is reduced, target cells become relatively insulin resistant

  4. The Pancreas • Main role is to excrete digestive enzymes • Islets of Langerhans contain alpha cells which excrete glucagon, and beta cells which excrete insulin • Glucose stimulates insulin secretion from beta-cells • Insulin binds with cells surface receptors to allow glucose transport into the cell • Glucagon mobilizes glucose to be released from the liver

  5. Symptoms of diabetes • Polydipsia (increased drinking) • Polyuria (increased urination) • Weight loss • Weakness • Increased infections • Blurred vision

  6. Complications • Macrovascular • Stroke • MI • Ulcers • Amputation • Microvascular • Retinopathy - blindness • Nephropathy – renal failure • Neuropathy – numbness, tingling, pain , sensory deficits, and autonomic involvement • Infections

  7. Lab tests - diagnosis • Random glucose • >11.0 mmol/L + symptoms • Fasting glucose • >6.9 mmol/L • Hb A1c • A long term measure of diabetic control • > 8%

  8. Emergencies • Ketoacidosis • In type 1 patients only • Marked hyperglycemia (high serum glucose) causes osmotic diuresis • Patient loses excess water, Na, K, and ketones released from the liver cause an acidosis • Precipitated by an infection, insulin error or omission, or occurs in a previously undiagnosed patient • Treated with insulin, fluid replacement, K replacement • Type 2 diabetics can have a much less serious variant of this called Hyperglycemic hyperosmolar nonketotic state

  9. Emergencies • Hypoglycemia • May occur with an overdose of insulin/oral medication or a missed meal • Only some medications cause hypoglycemia – Glyburide, Glicazide, Chlorpropamide • Patient gets diaphoretic, weak, shaky, palpitations, difficulty thinking, vision changes and may lose consciousness • Patient needs glucose – a glass of juice, a candy, or if comatose, IV 50% glucose solution, IM glucagon, glucose gel • Some patients are totally unaware of their hypoglycemia until they lose consciousness

  10. Medical management • The tighter the control, the fewer complications– BUT – the more risk of getting hypoglycemic • IDEAL management • Fasting glucose 4.0 – 7.0 mmol/L • 1-2 hour postmeal 5.0 – 11.0 mmol/L • Type 1 diabetes – insulin tx– usual starting dose about 20 units/day (testing 2-5 x/day) • Type 2 diabetes – oral hypoglycemics +/- insulin (testing 1-2x/day) - diet only (testing 2x/month) • Infection, stress, pregnancy, surgery will all disturb control

  11. Dental management • Assess control/severity • What medications are you taking (or diet only) • Type 1 vs Type 2 • When were they first diagnosed • How often do they measure their glucose • What are their usual measurements • Frequency of hypoglycemic reactions (can they feel them coming on?) • How much insulin do they use • When did they last see their doctor

  12. Your biggest worries: • Hypoglycemia during a procedure • Oral surgeries that will prevent the patients from getting their usual caloric requirements • Brittle diabetics (extreme fluctuations of hypo/hyperglycemia) – usually occurs after years of high dose insulin therapy • Acute oral infections that precipitate hyperglycemia • Be more aggressive with antibiotics in patients with high sugars

  13. Oral complications • Xerostomia • Infections – especially candidiasis • Increases caries • “Burning mouth syndrome” • So – test for diabetes in suspicious patients

More Related