Term
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Definition
| group of metabolic diseases characterized by high blood glucose levels (hyperglycemia) and the inability to produce and/or use insulin |
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Term
| What is type 1 diabetes caused by? |
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Definition
| primarily the result of pancreatic beta cell destruction and is characterized by insulin deficiency |
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Term
| What is type II diabetes characterizd by? |
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Definition
| characterized by insulin resistance and relative insulin deficiency |
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Term
| What are some of the other types caused by? |
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Definition
| attributed to genetic defects in beta cell function, as well as disease or infections that cause diabetes |
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Term
| What is gestational diabetes? |
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Definition
| is abnormal glucose tolerance that first appears or is detected during pregnancy |
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Term
| What are the two types of prediabetes? How often does it lead to diabetes? |
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Definition
1.impaired glucose tolerance
2.impaired fasting glucose
-11% after about 3 years |
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Term
| How does diabetes effect you metabolically and vascularly? |
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Definition
-The metabolic component involves the elevation of blood glucose associated with alterations in lipid protein metabolism
-The vascular complications involve premature macrovascular disease and serious microvascular disease |
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Term
| What can prevent or retard the development of microvascular complications of diabetes? |
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Definition
| maintenance of good glycemic control |
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Term
| What are eventual complications in nearly every person with chronic diabetes? |
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Definition
| Retinopathy and nephropathy |
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Term
| What do we need to know about a diabetic patient before appropriate dental care can be given? |
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Definition
-level of disease severity
-level of glycemic control
-the presence of complications from diabetes |
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Term
| How much of the american population has diabetes? |
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Definition
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Term
| What is the most prevalent type of diabetes? How much of the cases in america is this type? |
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Definition
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Term
| Who is type II diabetes seen in? |
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Definition
-incidence increases with age
-usually adult onset |
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Term
| Which type of diabetes is more prevalent in younger people? |
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Definition
| Type I is 4 times more prevalent in ppl younger than 20, even though it only accounts for 0.3% of americans |
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Term
| Has the prevalence of diabetes in the US increased or decreased over the past 40 years? |
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Definition
| increased more than six-fold |
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Term
| What are the reasons for the increase in diabetes? |
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Definition
**1.obesity epidemic(type II)**
2.increasing population
3.increasing life expectancy
4.increasing number of affected persons who are having children who will pass on the disease |
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Term
| What is Type I diabetes thought to be a result of? |
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Definition
1.genetic(30-40% of twins share it)
2.autoimmune(Autoantibodies against beta cell constituents are present in 85% to 90%)
3.environmental factors(viral infections could trigger autoimmune response)
4.unknown(10-15% of cases) |
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Term
| What are the causative components of type II diabetes? |
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Definition
1.genetic(to defects in insulin receptor function, etc.)
2.environmental(obesity and lack of exercise)
3.age-related components |
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Term
| What can the other types of diabetes be caused by? |
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Definition
-specific gene defects
-endocrine conditions(primary destruction of islet cells through inflammation, cancer, surgery, hyperpituitarism, or hyperthyroidism) |
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Term
| When does Iatrogenic disease occur? |
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Definition
| after steroid administration |
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Term
| How common is gestational diabetes? |
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Definition
| occurs in 5-7% of pregnant women |
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Term
| What is the most important stimulus for insulin secretion? |
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Definition
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Term
| How long does insulin remain in the blood stream? Where does it go? |
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Definition
-only for minutes then reacts with target organs
-glucose and enzyme transporter proteins are then released |
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Term
| What can lack or defect of insulin result in? |
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Definition
-abnormalities in carbohydrate, fat, and protein metabolism
-glucose accumulates in blood |
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Term
| What does hyperglycemia read to? |
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Definition
-glucose excretion in the urine, increased urine volume
-this leads to dehydration and loss of electrolytes |
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Term
| What is a hyperosmolar nonketotic coma caused from? Who is it seen in? |
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Definition
in type II diabetes when hyperglycemia is prolonged, the dehydration causes a decrease in urinary output
-seen in elderly people with type II diabetes |
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Term
| What does lack of glucose utilization by many cells of the body leads to? |
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Definition
| cellular starvation(pt will eat but still loose weight) |
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Term
| What can cellular starvation in type I diabetes lead to? |
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Definition
| severe acidosis which could lead to come and death |
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Term
| What are the primary manifestations of diabetes? What do these cause? |
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Definition
-hyperglycemia, ketoacidosis, and vascular wall diseas
-cause inability to fight infection and poor wound healing |
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Term
| How long can diabetes decrease your life expectancy? |
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Definition
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Term
| What type of diabetes does retinopathy occur in? What does it cause? |
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Definition
| all forms, causes blindness(leading cause in the US) |
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Term
| Who is proliferative retinopathy most common in? |
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Definition
| patients with type I diabetes |
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Term
| What is the risk of a diabetic person becoming blind compared to a normal person? |
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Definition
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Term
| What is the leading cause of death in type I diabetes? |
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Definition
| renal failure(diabetics are 25 more times likely to develop this) |
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Term
| Are people with diabetes at an increased chance for atherosclerosis? |
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Definition
| yes, hyperglyceima can cause this(increased LDL's, decreased HDL's) |
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Term
| What is the most common cause of death in type II diabetes? |
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Definition
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Term
| What can diabetic neuropathy lead to? |
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Definition
-burning tongue
-muscle weakness, muscle cramps, a deep burning pain, tingling sensations, and numbness |
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Term
| Diabetic neuropathy may also effect... |
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Definition
| the autonomic nervous system |
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Term
| What is diabetes associated with? |
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Definition
| skin rashes, deposits of fat in the skin (xanthoma diabeticorum), decubitus ulcerations, poor wound healing, and gangrenous extremities (40 times more likely to require amputation of an extremity) |
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Term
| What is the onset of symptoms like in Type I diabetes? |
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Definition
| sudden and acute, often developing over days or weeks |
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Term
| What are the symptoms of type I diabetes? |
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Definition
-polydipsia, polyuria, polyphagia, weight loss, loss of strength, marked irritability, recurrence of bed wetting, drowsiness, malaise, and blurred vision
-Patients also may present with ketoacidosis, which if severe is accompanied by vomiting, abdominal pain, nausea, tachypnea, paralysis, and loss of consciousness |
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Term
| When does type II diabetes generally occur, who does it effect? What is the onset of symptoms like? |
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Definition
-generally occurs after age 40 and more often affects obese persons
-insidious (gradual) |
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Term
| What are some symptoms of type II diabetes? |
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Definition
-polydipsia, polyuria, polyphagia, weight loss, and loss of strength
-skin lesions, cataracts, blindness, hypertension, chest pain, and anemia |
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Term
| Who should be screened for diabetes? |
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Definition
-people 45 and older
-obese people
-family history
-high LDL levels
-symptoms of diabetes |
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Term
| What does the diagnostic criteria for diabetes rely on? |
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Definition
the plasma glucose level, either...
-At a random sampling
-After fasting
-After a 75-g glucose test (oral glucose test, OGGT) |
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Term
| People who are going to get their glucose levels tested should not what? |
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Definition
| participate in excessive physical activity |
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Term
| What is the oral glucose tolerance test? (OGTT) |
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Definition
-reflects how quickly glucose is cleared from the blood
-Venous blood samples are drawn from the arm just before and most often at 2 hours after ingestion of the glucose
-Urine samples also are collected at each interval |
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Term
| What is the extent of glycosylation of hemoglobin A (a nonenzymatic addition of glucose) that results in formation of HbA1C (i.e., glycated hemoglobin) in red blood cells used to detect? |
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Definition
used to detect and assess the long-term level (and control) of hyperglycemia in patients with diabetes
**glucose levels in the blood over the preceding 2 to 3 months** |
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Term
| Is the determination of urinary glucose and acetone of value in detecting overt diabetes? |
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Definition
| no, it is of limited value |
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Term
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Definition
| no, but you can control it to greatly reduce complications |
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Term
| What is used to treat diabetes? |
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Definition
-oral hypoglycemic medications
-insulin injections/pumps
-eating healthy
-medications to address complications
-exercise |
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Term
| What is done if standard therapies fail? |
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Definition
pancreas and kidney transplantation or transplantation of pancreatic islet cells into the recipient’s
-many complications, only 60% survive after 10 years) |
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Term
| What is type I diabetes treated with? |
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Definition
-insulin injection(most common) or pump
-only human insulin used |
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Term
| When are rapid-acting and short-acting preparations of insulin used? What do intermediate-acting and long-acting act as? |
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Definition
-at meals
-intermediate and long acting act as basal injections |
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Term
| What are two rapid-acting insulin analogues are available? |
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Definition
| lispro and aspart, both last 3-4 hours |
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Term
| How fast does regular insulin last? How long is it given before a meal? How long is the duration of action? |
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Definition
about 30 minutes; thus, it is given about 30 minutes before a meal
-It has a short duration of action (approximately 5 to 8 hours) |
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Term
| What are long acting human insulins used to for? When do they take effect? |
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Definition
-to provide smooth basal insulin profiles
-They take effect within 8 hours and reach peak effect in 16 to 24 hours |
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Term
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Definition
| a noninsulin product, also is approved for the treatment of patients with type 1 and type 2 diabetes who have failed to achieve targets for glucose control despite optimal insulin therapy |
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Term
| What are the insulin regimens classified as? |
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Definition
| as conservative, intensive, or continuous |
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Term
| When is a conservative approach taken? |
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Definition
| -early stages of type 1 diabetes when some degree of beta cell function is still intact |
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Term
| How is the conservative approach given? |
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Definition
| Two daily subcutaneous abdominal injections consisting of a mixture of intermediate-acting or rapid-acting insulin are given, one before breakfast and one before dinner |
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Term
| What is a problem with the conservative approach? |
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Definition
| the peak glucose-lowering effect of the evening intermediate-acting insulin injection is around 3 AM, which can induce severe hypoglycemia |
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Term
| What does successful management often require? |
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Definition
intensive (multidose) injection throughout the day with self-monitoring finger sticks (120 minutes after meals) to ensure proper glucose levels are maintained
-utilize two to three rapid-acting insulin injections with one (or two) intermediate- or one long-acting insulin injection |
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Term
| What is used to treat type II dabetes? |
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Definition
-medications for systemic conditions
-lifestyle changes |
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Term
| What are the 4 classes of drugs to treat type II diabetes? |
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Definition
1.Insulin sensitizers
2.Insulin secretagogues
3.Drugs that slow the absorption of carbohydrates in the gut
4.Incretins |
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Term
| What are Insulin Sensitizers primary action on the liver? |
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Definition
-biguanides
-Metformin (Glucophage) suppresses hepatic glucose output and gluconeogenesis |
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Term
| What are insulin sensitizers primary action on peripheral tissues? |
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Definition
-thiazolidinediones (TZDs)
-Agonist of peroxisome proliferator-activated receptor gamma (PPARγ)—a family of nuclear transcription factors
Piogliazone (Actos) and rosiglitazone (Avandia) |
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Term
| What are Insulin Secretagogues? |
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Definition
| Agents that bind to the sulfonylurea receptor on the plasma membrane of pancreatic beta cells, causing insulin secretion from the pancreas |
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Term
| Are first generation or second generation Insulin Secretagogues more potent? What are the medications? |
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Definition
-Second-generation agents are more potent and have fewer adverse effects and drug interactions than those typical for first-generation drugs
-Glipizide and glimepiride can be dosed once daily and have a relatively low risk of hypoglycemia and weight gain |
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Term
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Definition
| Repaglinide (Prandin) and nateglinide (Starlix) increase the secretion of insulin in the presence of glucose in a manner similar to that for the sulfonylureas; however, they are more rapid in action and of shorter duration |
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Term
| When should Glinides be taken? What do they provide? |
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Definition
| They are dosed with each meal and provide good postprandial control of glucose |
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Term
| What do Alpha-Glucosidase Inhibitors (AGIs)do? |
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Definition
| at the brush border of the intestinal epithelium, thus blocking the absorption of carbohydrates in the small intestine |
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Term
| When are the administrated? What is two examples of this drug? |
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Definition
-They are administered with the first bite of a carbohydrate-containing meal and limit postprandial hyperglycemia without causing hypoglycemia
-Two AGI drugs are marketed in the United States, acarbose (Precose) and miglitol (Glyset) |
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Term
| What are two combinations of a sulfonylurea and a biguanide? |
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Definition
| are Glucovance (glyburide plus metformin) and Metaglip (glipizide plus metformin) |
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Term
| What do Dipeptidyl Peptidase-4 Inhibitors do? |
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Definition
-blocks the enzymes responsible for the breakdown of incretins
-Agents such as sitagliptin (Januvia) have been shown to provide good glycemic control in monotherapy or when combined with metformin |
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Term
| Which patients with type II diabetes reguires insulin? |
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Definition
| Patients with type 2 diabetes with failing beta cell function may require insulin therapy to gain tighter glycemic control |
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Term
| What are Incretin Mimetics? |
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Definition
-Incretins are a group of GI hormones that increase insulin release from beta cells in the pancreas
-incretin response is diminished ordefective in type II diabetes |
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Term
| What are four drugs that target the incretin pathway are available for use in management of type 2 diabetes? |
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Definition
-Exenatide (Byetta) is an incretin GLP-1 mimetic and a synthetic form of exendin 4
-Liraglutide also is a GLP-1 agonist that is long acting and has the advantage of once-daily injectable dosing
-Sitagliptin (Januvia) and saxagliptin (Onglyza) are inhibitors of dipeptidyl peptidase-4 (DDP-4), the enzyme responsible for degradation of incretin hormones (GLP-1 and GIP) |
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Term
| What is another more recently developed approach to type 2 diabetes treatment? |
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Definition
is to use an analogue of human amylin(modulates gastric emptying)
-effect—preventing postprandial rise in serum glucagon—but also suppresses appetite |
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Term
| What is Pramlintide (Symlin)? |
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Definition
| a synthetic form of amylin, is approved only as an adjunct to insulin therapy |
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Term
| Patients treated with insulin must closely managed their what? |
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Definition
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Term
| How does reaction of shock to excess insulin occur? |
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Definition
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Term
| What is the mild stage characterized by? |
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Definition
-hunger
-weakness
-trembling
-tachycardia
-pallor
-sweating
-paresthesia may be noted on occasion |
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Term
| When may the mild stage be seen? |
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Definition
| It may occur before meals, during exercise, or when food has been omitted or delayed |
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Term
| What occurs in the moderate stage? |
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Definition
-incoherent
-uncooperative
-sometimes belligerent or resistant to reason or efforts at restraint
-judgment and orientation are defective |
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Term
| What is the cheif danger in this phase? |
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Definition
| the person may injure themselves or someone else |
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Term
| What occurs in the severe stage? |
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Definition
-Complete unconsciousness with or without tonic or clonic muscular movements occurs during the severe stage
-Sweating, pallor, rapid and thready pulse, hypotension, and hypothermia may be present |
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Term
| When may the severe stage occur? |
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Definition
-during sleep after the first two stages have gone unnoticed
-also may occur after exercise or after the ingestion of alcohol, if earlier signs have been ignored |
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Term
| What is used to treat people in the severe stage? |
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Definition
| an intravenous glucose solution; glucagon or epinephrine may be used for transient relief |
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Term
| Patients with an estimated fasting blood glucose level of BLANK mg/BLANK mL or higher should be referred to a physician for medical evaluation and treatment, if indicated. |
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Definition
| Patients with an estimated fasting blood glucose level of 126 mg/100 mL or higher should be referred to a physician for medical evaluation and treatment, if indicated |
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Term
| Those with a 2-hour postprandial blood glucose level of BLANK mg/100 mL or higher also should be referred |
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Definition
| Those with a 2-hour postprandial blood glucose level of 200 mg/100 mL or higher also should be referred |
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Term
| How often should patients older than 45, obese, and with a family history of diabetes be screened? |
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Definition
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Term
| How often should women who give birth to big babies or have multiple stillborns be screened for diabetes? |
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Definition
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Term
| What are two examples of personal blood glucose monitoring devices? |
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Definition
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Term
| Do Patients with type 2 diabetes who have no evidence of complications and whose disease is under good medical control as determined by consultation with the patient’s physician require any treatment modificatons? |
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Definition
| not unless they develop an infection i their mouth with swelling or fever |
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Term
| Patients with complications such as BLANK disease or BLANK disease may require specific alterations in dental management. |
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Definition
| renal or cardiovascular disease |
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Term
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Definition
| Patients who have not seen a physician for a long time, who have had frequent episodes of insulin shock, or who report signs and symptoms of diabetes may have disease that is unstable |
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Term
| patients who experience hypoglycemia have what form of diabetes? |
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Definition
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Term
| Who else is a med con indicated for? |
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Definition
| patients with type I diatebes who are under insulin management wheo still experience hyperglycemia and hypoglycemia even under good medical management |
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Term
| What is a major goal of treating a diabetic patient? |
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Definition
| making sure they do not go into shock during treatment |
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Term
| What is the protocol for intravenous sedation of a diabetic patient? |
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Definition
| involves fasting before the appointment (i.e., nothing by mouth after midnight), using only half the usual insulin dose, and then supplementing with intravenous glucose during the procedure |
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Term
| Can diabetic patients be given anesthesia? |
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Definition
| may be given general anesthesia, if necessary; however, in a dental office, management with local anesthetics is preferable |
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Term
| Who is at a high risk for infecton? Are prophylaxis antibiotics indicated? |
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Definition
-people with brittle diabetes or who require high doses of insulin(type I)
-antibiotics generally not administered |
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Term
| People with brittle diabetes may require what for treatment of infection? |
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Definition
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Term
| What is risk for infection of diabetic patients related to? |
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Definition
| their fasting glucose level- between 207 and 229 mg/100 mL, the risk is predicted to be increased by 20% if surgical procedures are being performed |
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Term
| Who is antibiotic sensitivity testing recommended for? |
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Definition
| for patients with brittle diabetes and for those who require a high insulin dosage for control |
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Term
| Can epinephrine be used on diabetic patients? |
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Definition
-yes has opposite effect of insulin so glucose may raise with use
-1:100,000 epinephrine can be used
- |
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Term
| What are some oral complications found with uncontrolled diabetes? |
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Definition
-Xerostomia
-Bacterial, viral, and fungal infections
-Poor wound healing
-Increased incidence and severity of caries
-Gingivitis and periodontal disease
-Periapical abscesses
-Burning mouth syndrome |
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Term
| What oral manifestation does hyperglycemia cause? |
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Definition
| The effects of hyperglycemia lead to increased amounts of urine, which deplete the extracellular fluids and reduce the secretion of saliva, resulting in dry mouth |
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Term
| What is diabetes associated with? |
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Definition
| type I and II is associated with periodontal disease, it is not just the increased plaque that causes it |
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