Diabetes therapy- Dental Therapeutics.txt
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What are the types of oral antidiabetic drugs?
- - biguanides
- -Alpha glucosidase inhibitors
What drugs sensitize the body to insulin and or control hepatic glucose production
- Biguanides--> metformin
What drugs stimulate the pancreas to make more insulin
What drugs slow absorption of starches?
Alpha glucosidase inhibitors
Do biguanides decrease blood glucose levels?
No they do not
Do sulfanylureas decrease blood glucose levels?
Yes they can cause HYPOGLYCEMIA
Meglitinides main mechanism of action is
Decrease post Prandial glucose levels
What are the adverse effects thiazolidinediones?
- -weight gain and edema
- - hypoglycemia
- - contribdicatednin patients with
- --abnormal liver function and CHF
What are the adverse effects of the biguanides?
- Diarrhea and abdominal discomfort
- - lactic acidosis if improperly prescribed
- - LDL cholesterol decrease
- Contraindicated with inpaired renal function
What are the adverse effects of the sulfonylureas?
- - weight gain
What are the adverse effects of meglitinides?
- -weight gain
What are the adverse effects of alpha glucosidase inhibitors
- -abdominal discomfort
- Contraindicated in patients Witt cirrhosis and inflammatory bowel disease
What is the criteria for diagnosis of diabetes post Prandial?
- Normal= < 140 mg/dl
- Impaired=140-199 mg/dl
- Diabetes= 200 or more
What is the criteria for diagnosing diabetes fasting glucose level
- Normal = <110 mg/ dl
- Impaired = 110-125 mg/ dl
- Diabetes >= 126 mg/dl
What is the significance of hbA1C?
Describes average blood glucose over the last 2-3 months
- - target range is 6.5 or below
- - do not treat if 8 or over equivalent to 205 mg/ dl
How many times should hba1c be taken per yr
- 2 times if not on insulin
- 4 times if takin insulin
How do you manage type I diabetics clinically?
- - morning appointments
- - if NPO skip morning insulin
- - do not resume normal insulin until normal caloric intake established
- - have glucose source available
- - aggressively treat oral infections
- - routine post procedural antibiotics are inappropriate
How do you manage type II diabetics in the clinical setting for minor procedures
- W LA
- - use usual medication if blood glucose is controlled
- NPO for 8 hrs and withhold AM medications and long term medications the evening before, resumed after surgery
How do you manage type II diabetics for moderate procedures?
- - oral medication withheld the evening before
- - NPO for 8 hrs
- - long acting sulfonylureas converted to short acting agents a few days in advance
- - metformin on discontinued 48 hrs before
- - check blood glucose insulin may be required
- - all poorly controlled diabetics reschedule
How do you manage type II diabetics undergoing major surgery?
- - modify and hold mess like moderate procedure
- - treat with insulin like type I diabetics
- - hospitalization for surgery may be needed
- - treat type II diabetics on insulin like you treat type I
What would you like to do?
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