CC OS - DIABETES

Cards (60)

  • Diabetes Mellitus

    A complex disorder of carbohydrate, fat, and protein metabolism that is primarily due to lack of insulin secretion by the beta cells of the pancreas or of defects of the insulin receptors
  • Classification of Diabetes Mellitus

    • Type 1 - Insulin dependent diabetes mellitus (IDDM)
    • Type 2 - Non-insulin dependent diabetes mellitus (NIDDM)
    • Gestational diabetes mellitus
    • Impaired glucose tolerance (IGT)
  • Incidence and Prevalence of Diabetes Mellitus
  • Diabetics may have other co-existing conditions
  • Patients Who Have To Be Screened For Diabetes Mellitus

    • - HDL cholesterol level ↓35mg/100ml
    • Triglyceride levels >250mg/100ml
    • Obese
    • Sudden loss of weight
    • Older than 45yo
    • Gestational Diabetes Mellitus
    • Delivered large babies (> 9 lbs)
    • Spontaneous abortions or stillbirths
    • Relatives with DM
  • Cardinal Symptoms of Diabetes Mellitus

    • - Polydipsia
    • Polyphagia
    • Polyuria
    • Obesity
    • Sudden weight loss
    • Weakness
  • Acanthosis Nigricans

    A skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened.
  • Other Areas of Acanthosis Nigricans
  • Laboratory tests for Diabetes Mellitus

    • - Fasting blood sugar (FBS)
    • 2-hour postprandial blood sugar
    • Random blood sugar (RBS)
    • Oral glucose tolerance test
  • Measurement Systems for Blood Sugar
    • mg/100ml of blood
    • mmol/1 liter of blood
    • mmol/1 liter of blood x 18 = mg/100 ml of blood
  • Glycosylated Hemoglobin

    Measures the percentage of blood sugar attached to hemoglobin. Monitors the glucose control of diabetics over time.
  • Glycosylated Hemoglobin Test Frequency
  • Hyperglycemia
    Metabolic disorder associated with diabetes mellitus characterized by high concentration of sugar in the blood
  • Blood sugar values
    • - Fasting blood glucose:
    • Normal: <100mg/dl or 5.6mmol/L
    • Pre-diabetes: 100-125 mg/dl or 5.6-6.9 mmol/L
    • Diabetes: >125mg/dl or 7.0 mmol/L on two separate tests
    • 2-hour post prandial (after meal) blood glucose:
    • Normal: <140 mg/dl or 7.8 mmol/L
    • Prediabetes: 140-199 mg/dl or 7.8-11mmol/L
    • Diabetes: > 199 mg/dl or 11.0 mmol/L
    • Random plasma blood glucose: concentration higher than 200 mg/dl or 11.1mmol/L
  • Goal of medical management
  • Xerostomia
    Polyuria → Depletion of extracellular fluids → Reduced salivary secretion
  • Neuropathy
    Burning mouth symptoms, Paresthesia and tingling, Numbness Pain
  • Oral Complications and Manifestations of Diabetes Mellitus

    • - Infection (Bacterial, Fungal)
    • Lichen planus
    • Ulcerations
  • Effect of Increased Glucose Concentration in Saliva
    Increased susceptibility to dental caries
  • Effect of Diabetes Mellitus on Periodontal Tissues
    Decreased PMN functions (chemotaxis and phagocytosis), Poor wound healing, Periapical abscess, Acute fascial space infections
  • Effect of Periodontal Disease on Diabetes Mellitus

    The inflamed periodontium is highly vascular, and the ulcerated pocket epithelium may serve as a portal to the systemic circulation for bacterial products and locally produced inflammatory mediators
  • Pro-inflammatory Cytokines

    • - Interleukin-1 beta (IL-1ß)
    • Interleukin-6 (IL-6)
    • Tumor necrosis factor-alpha (TNF-a)
  • Effect of Pro-inflammatory Cytokines

    Antagonize insulin action, Interfere with lipid metabolism, Cause insulin resistance
  • Stress
    Any event in which environmental demands, internal demands or both tax or exceed the adaptive resources of an individual, social system or tissue system
  • Significant Alterations To Glucose Metabolism Occur Under Conditions Of Stress
  • Effects of Increased Sympathomimetic Activity

    • Enhances glycogenolysis in the liver and skeletal muscles
    • Increases gluconeogenesis in the liver
  • Effects of Increased Pro-inflammatory Cytokines

    • Cause insulin resistance
    • Inhibit insulin release
    • Interfere with lipid metabolism
  • Increased Release of Counter-regulatory Hormones

    • - Cortisol: Directed toward acute provision of energy, protection against excessive inflammation
    • Glucagon: Stimulates breakdown of glycogen stored in the liver, activates hepatic gluconeogenesis
  • Insulin Reaction

    Excessively low blood sugar level (hypoglycemia), usually lower than 50 mg/dL
  • Causes of Insulin Reaction
  • Stress Conditions May Bring About
    • Increased Sympathomimetic Activity
  • Increased Sympathomimetic Activity
    Release of epinephrine from the adrenal medulla
  • Effects of Epinephrine
    • Helps the body cope up with stressful situations
    • Enhances glycogenolysis in the liver and skeletal muscles
    • Increases gluconeogenesis
  • Pro-inflammatory cytokines

    Cause insulin resistance, inhibit insulin release and interfere with lipid metabolism
  • Increased release of counter-regulatory hormones

    • Cortisol
    • Glucagon
  • Cortisol
    Effects are directed toward acute provision of energy, protection against excessive inflammation
  • Glucagon
    Stimulates breakdown of glycogen stored in the liver, activates hepatic gluconeogenesis
  • Causes of Insulin Reaction
    • Increased activity
    • Late or missed meals
    • Drinking alcohol without eating
    • Errors in insulin dosage
    • Uneven absorption of insulin after injection
    • Addition of an oral drug to treat diabetes
    • Deterioration of kidney function
  • Signs and Symptoms of Mild Insulin Reaction

    • Hunger
    • Warmness
  • Signs and Symptoms of Moderate Insulin Reaction

    • Sweating
    • Trembling
    • Anxiety
    • High heart rate, pounding heart
    • Headache