Diabetes Mellitus patients in dental managementPresentation Transcript
Diabetes Mellitus patients in dental management Reporter : 吳和泰 Modulator: Dr. 雷文天
Diabetes mellitus is a metabolic disorder characterized by relative or absolute insufficiency of insulin , and resultant disturbances of carbonhydrate metabolism .
The major function of insulin is to counter the concerted action of a number of hyperglycemia-generating hormones and to maintain low blood glucose levels.
6% (16 million persons) of the general population in the US have diabetes mellitus.
Almost 20% of adult older than 65 y/o have DM.
A dental practice serving an adult population of 2,000 can expect to encounter 40-80 persons with diabetes, about half of whom will be unaware of their condition.
National Institutes of Health, Aug 2001
Etiologic classification of DM
There are two types of Diabetes Mellitus:
Type 1 , insulin-dependent or, juvenile-onset diabetes (IDDM)
Type 2 , non-insulin-dependent, adult-onset diabetes (NIDDM)
Other specific types
JADA, Oct 2001
Type 1 (IDDM)
Autoimmune destruction of the insulin-producing beta cells of pancreas.
5-10% of DM cases.
Common occurs in childhood and adolescence , or any age.
Absolute insulin deficiency.
High incidence of severe complications .
Prone to autoimmune diseases . (Grave’s, Addison, Hashimoto’s thyroiditis)
Type 2 (NIDDM)
Result from impaired insulin function . (insulin resistance)
Constitutes 90-95% of DM
Specific causes of this form are unknown .
Risk factors : age, obesity, alcohol, diet, family Hx and lack of physical activity ..etc.
mild beta-cell depletion severe beta-cell depletion focal atrophy and amyloid deposits marked atrophy and fibrosis no insulitis insulitis early Islet Cells relative insulin deficiency severe insulin deficiency insulin resistance autoimmunity, immunopathologic mechanisms Pathogenesis No HLA association human leukocyte antigen (HLA)-D linked ketoacidosis rare ketoacidosis common Genetics no anti-islet cell antibodies anti-islet cell antibodies normal or increased blood insulin decreased blood insulin obesity normal weight onset >30 years onset <20 years Clinical Type 2 Type 1 Comparison
Other specific types
Genetic defects of beta-cell functions
Decrease of exocrine pancreas
Drug or chemical usage
Gestational diabetes mellitus (GDM)
Defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
4% of pregnancy in US.
Healthy people blood glucose level maintained within 60 to 150 mg/dL .
Insulin synthesized in beta cells of pancreas and secreted rapidly into blood in response to elevations in blood sugar.
Promoting uptake of glucose from blood into cells and its storage as glycogen
Fatty acid and amino acids converted to triglyceride and protein stores.
Lack of insulin or insulin resistance, result in inability of insulin-dependent cells to use glucose .
Triglycerides broken down to fatty acids blood ketones ↑ diabelic ketoacidosis .
As blood sugar levels became elevated ( hyperglycemia ), glucose is excreted in the urine and excessive of urination occurs due to osmotic diuresis ( polyuria ).
Increased fluid loss leads to dehydration and excess thirst ( polydipsia ) .
Since cells are starved of glucose, the patient experiences increased hunger ( polyphagia ).
Paradoxically, the diabetic patient often loss weight , since the cells are unable to take up glucose.
People with DM have an increased incidence of both microvascular and macrovascular complications.