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Medical Emerg. (16) Diabetes related emergencies

Terms in this set (38)

Diabetes mellitus
autoimmune metabolic disorder characterized by hyperglycemiac
Beta cells in the pancreas produce
insulin
insulin is ______________to aid in the conversion and transportation of blood sugar to cells of the body and is used for ___________.
related; energy
Elevated levels of blood _______________ocurs when the pancreas does not produce enough or any insulin for transportation to the body's cells or when there's defects in the receptor cells
glucose
what are the three types of diabetes
-type I (formerly IDDM or Juvenile)
-type II (formerly NIDDM or adult onset)
-gestational (pregnant women)

*4th category: pre diabetics or impaired glucose tolerance
diabetes type 1:
-absolute lack of circulating insulin
-pancreatic beta cells within islets of langerhans are destroyed due to immune dysfunction
-insulin dependent for survival
-accounts for 5-6% of all diabetics
diabetes type II
-pancreas unable to produce sufficient insulin or the body not able to use the insulin that is produced
-increasing number of this type accounting for about 990-95% of all diabetics
-due to: increase in life span, sedentary lifestyle, obesity
-adolescence incidence rising due to lack of exercise and poor diets
gestational diabetes
-occurs in 2-4% of pregnant women
-glucose intolerance with initial onset during pregnancy; caused by an enzyme in the placenta and destruction of insulin by placenta.
-usually resolves after pregnancy, but can return years later
affects on infant from gestational diabetes:
-fetal macrosomia (big baby syndrome)
-hypoglycemia
-hypocalcemia
-hyperbilirubinemia: too much bilirubin in infant's blood and the newborn's liver cannot process the bilirubin causing jaundice. Bilirubin is produced in the liver, when the liver breaks down red blood cells
diabetes testing: what are the two types
-fasting plasma glucose test FPG
-oral glucose tolerance test OGTT
fasting plasma glucose test FPG
12-14 hour fast:
-blood glucose between 100-125mg/dL: pre-diabetes
-blood glucose over 126mg/dL diabetes
Oral Glucose Tolerance Test (OGTT)
12-14 hour fast and then drinking a glucose-rich beverage
2hours later blood glucose:
-140-199mg/dL pre-diabetes
-200 or more mg/dL diabetes
4 major systemic complications:
-diabetic retinopathy
-diabetic neuropathy
-diabetic nephropathy
-oral manifestations
diabetic retinopathy
-leading cause of blindness ages 20-74
-progresses from mild form: increased vascular permeability to moderate form:vascular closure
-severe form: growth of new blood vessels on retina and posterior surface of vitreous
-macular edema or retinal thickening from leaky blood vessels can develop at all stages of retinopathy

**prevention: early screening for diabetes and glucose control
diabetic neuropathy:
-mild to severe forms of nervous system damage affecting 60-70% of diabetics
*common symptoms:
-pain in the hands &feet (stinging, throbbing, tingling)
-slow digestion
-other neurological problems (affects urinary tract and blood vessels)
microvascular and macrovascular complications
-microaniopathic changes where the basement membrane of the capillaries thickens and can lead to the formation of thrombi, impeding blood flow
-diminished blood flow can increase the risks of a stroke (CVA) and or myocardial infarctions
-lack of blood flow to nervous tissues can damage the nerves
-gangrene:loss of blood to a part of the body increasing the risk of losing a limb
diabetic nephroopathy
-damages small blood vessels in kidneys
-impairs ability to filter impurities from blood
-requires transplant or dialysis to cleanse blood
-once it occurs, 100% morbidity within 10years
oral manifestations of diabetes:
increased incidence of:
-delayed wound healing leading to secondary oral and systemic infections
-perio disease
-abcesses
-xerostomia:dry mouth
-lichen planus
-canidiasis: yeast infection in oral cavity
glucose monitoring and testing:
-glucometer testing
-HbA1c or glycated hemoglobin test
glucometer testing:
-normal reading 50-150mg/dL
-less than 50: hypoglycemic
-greater than 150: hyperglycemic
HbA1c or glycated hemoglobin test
-average blood glucose level over past 2-3months
-over 6.5% : diabetic
-between 5.7%-6.4% : pre-diabetic
medications and treatments for type I diabetes:
-insulin: humalog, novalog is the most common*
-insulin pumps: replace daily injections
-pancreas or pancreatic islet cell transplantation
medications and treatments for type II diabetes:
-metformin (glucophage)
-tolbutamide (orinase)
-hylburide (micronase, diabeta, glynase)
questions to ask ALL diabetic patients:
-do you monitor your blood sugar levels? how often?
-how are you feeling
-do you take medication, if so did you take it today?
-are you having any problems with your eyes, feet, legs?
-do you see your physician regularly?
-do you see an eye doctor yearly?
-do you know your avg hemoglobin value?
the following questions must be documented in clinical chart
-what type of diabetes do you have?
-when were you diagnosed?
-did you eat today, what did you eat?
-do you test your blood glucose levels daily? if not how often?
-what was your blood glucose value today? or most recent?
-how often do you see your medical doc?
-have you ever had a diabetic medical emergency?
-what is your most recent HbA1c?
dental tx considerations for diabetic pts
-schedulet appts in early to mid morning
-short appointments
-*instruct pts to continue normal dietary intake prior to appointment
-ck pts blood glucose level prior to any invasive procedure or if pt complains of not feeling well
-frequent recall exams and prophylaxis
-use of topical fluoride
-recomm saliva substitutes
diabetic medical emergencies:
-diabetick ketoacidosis: severe hyperglycemia or insufficient blood insulin; occurs when body attempts to revers acidosis caused by metabolized fatty acids by exhaling excess co2, results in tachypnea and increased depths of respirations aka kussmauls respirations or air hunger pt will have fruity breath*

-hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)-yperglycemic and dehydrated; usually elderly, institutionalized, neglected, mentally challenged

-hypoglycemia or hyperinsulinism: insulin shock blood glucose is too low; below 50mg/dl and insulin is too high
diabetic medical emergency may happen when the patient:
-increases insulin dosage, omits a meal, vomits, or exercises excessively
An absolute lack of circulating insulin is characteristic of which condition?
type I diabetes
a result of 115 mg/dL on a fasting plasma glucose test would indicate
prediabetes
what causes the gangrene that is often associated with diabetic patients?
microangiopathic changes
all of the following are oral complications associated with diabetes except on. which is the exception?
-perio disease
-xerostomia
-candidiasis
-squamous cell carcinoma
-squamous cell carcinoma
which diabetic emergency is associated with the following syptoms:
-tachypnea
-kussmauls breathing
-nausea
-blurred vision
-fruity odor on the breath
-diabetic ketoacidosis
what is the needed treatment for diabetic ketoacidosis
administration of insulin
the test used to measure a diabetic's average glucose level over the past tree months is:
HbA1c test
all of the following are symptoms of hypoglycemia in a diabetic patient except which one
-confusion
-profuse sweating
-aggressive behavior
-cyanosis
cyanosis
what is the diabetic emergency that is often seen in institutionalized individuals
hyperosmolar hyperglycemic state
all of the following are medications often prescribed for the type II diabetics except one, which one?
-glucagon
-metformin
-glyburide
-tolbutamide
glucagon
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