ch 65 diabetes
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what is a group of metabolic diseases characterized by HYPERglycemia, which results from a defect in insulin secretion, action or both called?
insulin is produced by ____ cells within the _____. it effects which organs in the body? is it directly or indirectly?
- beta cells
- EVERY ORGAN
- both directly or indirectly
what happens to the glucose level when insulin facilitates glucose uptake from blood into tissues?
it lowers the blood glucose level
t/f insulin speeds the oxidation of glucose in the cells to use for energy
what speeds the conversion of glucose to glycogen to store in the liver and skeletal muscles and to prevent the conversion of glycogen back to glucose?
our friend INSULIN!
insulin facilitates conversion of glucose to ____ and _____ tissue
what are the two types of diabetes?
which diabetes is a DECREASE in insulin?
which diabetes is a decrease of ACTION of insulin?
type 1 diabetes causes less glucose being transmitted to cells increasing glucose levels in circulating blood, which is ________
what happens in type 1 diabetes if glucose reaches a threshold in the blood? what does it cause?
- it spills over into the urine (glycosuria)
- polyuria (excessive urination), causing loss of water and electrolytes
which type of diabetes causes fluid loss signals excessive thirst to the brain (polydipsia)?
t/f type 1 diabetes, is where the cells are starving for glucose, so the patient may eat more (polyphagia) but still result in weight loss
loss of glucose in type 1 diabetes = loss of ______. what does the body metabolize instead in this case?
why does having the body metabolize fat for energy cause harm? (what are the end products of fat metabolism)
ketones that accumulate in the blood (type 1)
ketones are _______ when accumulated, they ______ the blood
- (type 1)
which type of diabetes is the normal production of insulin from the pancreas, but the surface of the cells have defects and glucose cannot be transmitted into the cell, leading to blood glucose levels increasing, which leads to the stimulation of more insulin to release.
t/f type 1 diabetes is over time insulin secretion may decline, causing a decrease in insulin in the blood and increase insulin resistant in cells
FALSE! type 2!
what are risk factors for type 1 diabetes?
autoimmune disease where the body's immune system destroys BETA cells that produce insulin that can be predisposed by genetic factors as well as environmental, such as a virus
had a baby, weighed more than 9 lbs
polycystic ovary syndrome
hypertension of 140/90
45 or older
HDL less than 35 mg/dl
tryglycerides over 250 mg/dl
impaired glucose tolerance levels
history of vascular disease
acanthosis nigrans (skin disorder)
are all risk factors for type ___ diabetes
the "poly's" are signs and symptoms of which type of diabetes?
- type 2
- polyuria-excessive urination
- polydipsia-excessive thirst
- polyphagia-excessive eating
what are 3 genetic syndromes associated with diabetes?
- down syndrome
- huntington's chorea
- prader-willi syndrome
what are the 8 complications associated with diabetes?
- peripheral neuropothy
- autonomic neuropothy
- cardiovascular disease
- pregnancy complications
- silent killer
t/f someone with diabetes is prone to infection and impaired healing
with a pt with diabetes, what are the four places infections are involved?
- urinary tract
- oral cavity (hey! this is where we come in!)
failure to treat an infection _________ the symptoms of diabetes and increases what?
- increases the severity
insulin may increase with an infection due to _____, infection, inflammation, _______, bleeding, ____ or stress
what is pain, numbness or tingling of the mouth, face and extremeties leading to foot ulcerations or infections because they can't feel pain leading to amputations and charcot's joints called?
what causes GI tract symptoms like gastropariesis, and food may harden causing obstruction in the intestines or stomach or may cause overgrowth of bacteria?
what causes hypertension or abnormalities in lipoprotein metabolism, or sexual dysfunction?
what is retinopathy?
- cataracts and glaucoma
what cardiovascular diseases contribute to diabetes
- heart disease
- peripheral vascular disease
- cerebrovascular disease
- MI or stroke
- coronary heart disease
what are some pregnancy complications with diabetes? 3
- birth defects
- increased weight
what effects daily life for pt and those around, and can lead to emotional and social problems including depression?
why is diabetes a silent killer?
- the average lifespan is reduced
- diabetes and its complications are LEADING CAUSES OF DEATH
what is a normal blood glucose level?
what happens if glucose accumulates above 150 mg/dl?
t/f the oral glucose tolerance test is the standard of diagnosing diabetes
FALSE! it is NO LONGER the standard
what is a test that gives a pt 75g or 100 g of glucose after a night of fasting, followed by blood testing up to 5 hour intervals checking the metabolic breakdown of the glucose by what is still in the blood? urine is also checked to make sure there is no glucose in it.
oral glucose tolerance test
what is the best test for monitoring blood glucose levels?
FPG Fast plasma glucosing
what is the FPG?
pt fasts for 8-14 hours prior to blood draw
<126 mg/dl =
<160 mg/dl =
what is HbA1c?
glycated hemoglobin assay
what does checking for HbA1c do?
shows the presence of hyperglycemia (normal=6-8% of HbA1c, well controlled needs to be <7%)
HbA1c measures the amount of glucose _________ bound to a hemoglobin molecule
when is the HbA1c performed in patients taking insulin?
if someone comes into the office for dental treatment and their blood sugar level is <70mg/dl, what is to be done prior to treatment?
give sugar to raise level
what if someone comes in for dental treatment and their level is >126 mg/dl?
refer to physician for medical evaluation
t/f all type 1 diabetes may need insulin for control of diabetes. all type 2 diabetes pt's require insulin for survival
FALSE! they are opposite
t/f doses of insulin is standardized for individuals
false! it depends on the individual
what is the objective of doses of insulin?
attain optimum glucose levels in each 24 hour period
what are 5 factors affecting the need for insulin?
- food intake
- variations in exercise
what are the three methods for insulin administration?
- subcutaneous (syringe in abdomen, thighs, upper arm)
- subcutaneous infusion with battery operated insulin pump (greater flexibility, but increased risk for hypoglycemia)
- inhalablel insulin (lower lung function, dry mouth, couch, chest discomfort)
what are the 5 types of insulin?
what prevents liver glycogen breakdown to glucose and increases tissue sensitivity to insulin?
biguanides (type 2)
what increases tissue sensitivity to insulin, and decreases hepatic glucose production?
thiazolidinediones (type 2)
what stimulates insulin release by the pancreas, but may cause hypoglycemia (meglitinides) and lowers blood glucose by increasing insulin released by the pancreas (may also cause hypoglycemia)?
sulfonylureas (type 2)
why is it important to monitor a diabetic patient for depression?
it can lead to lack of good oral hygiene and a lack of exercise
why is exercise needed especially in a diabetic?
it produces endorphins and prevents weight gain/obesity
t/f perio infections affect blood glucose levels in diabetes
what might sudden deterioration of periodontal health indicate?
undiagnosed diabetes or reduced control of diabetes
t/f pt's at a younger age with diabetes can have a more sever perio disease
diabetes acts as a ______, ______, and accelerating factor for disease
inadequate dental biofilm control contributes to more severe tissues response because of what?
tx of perio and reduction of inflammation is associated with improved metabolic control of what?
reduced level of HbA1c
what is an opportunistic fungal infection commonly associated with hyperglycemia and in those with uncontrolled diabetes?
mucormycosis is found in patients with _______ diabetes
t/f quadrant or area scaling reduces the possibility of perio abscess
xerostomia is a contributing factor to ______ _______
what are the yes/no questions for screening of diabetes? 6
- ever been diagnosed with diabetes?
- family member ever been diagnosed?
- do you urinate more than 6 times/day?
- dry mouth?
- unexplained weight loss?
how is a well controlled diabetic patient treated?
the same as the rest of us
what do you do if your patient has uncontrolled diabetes?
defer until diabetes is stabilized, unless emergency situation
what should you consult the physician for?
possible antibiotic premed
pt should be treated on a(n) ______ stomach
what insulin levels should be avoided when treating a diabetic patient?
what is the ideal time for a diabetic to come into the office?
wheneva! it varies with pt's lifestyle and insulin intake
If a pt eats breakfast at 6 and their appt is at 9, is their stomach still full?
what is the preferred appt times for a diabetic?
morning, after normal breakfast and meds, during ascending portion
what should you ALWAYS ask a diabetic?
if they have EATEN!
in a diabetic emergency, what should be given to a conscious patient?
- glucose gel
- cake frosting
- jar or baby apple-juice
in a diabetic emergency, what should be given to an unconscious patient?
diabetes insipidus should not be confused with diabetes _______. diabetes insipidus is a ____ disease characterized by polyuria and polydipsia. it is induced by an __________ hormone defect
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