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Diabetes CPR
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Diabetes CPR




Forth Year



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Diabetes CPR Presentation Transcript

  • 2. Outlines Definition  Classifications  Clinical manifestations  Oral manifestations  Diagnosis  Complications  Management  Hypo/ and hyper/glycemia 
  • 3. DIABETES MELLITUS  Definition A disorder of glucose metabolism -- hyperglycemia due to decrease insulin secretion or decrease its activity or both  Normal glucose level  80 - 100 mg /100ml blood  BS < 50 mg-----------hypoglycemia in adults  BS < 40 mg-----------hypoglycemia in children 
  • 4. Fasting glucose level
  • 5. Predisposing factors Genetic factor “if both parent ---100% offsprings”  Disorders destroying islets of langerhans  Other endocrine dysfunctions  Corticosteroids  Iatrogenic diabetes 
  • 6. Classification of diabetes Depending on age  adult onset DM  juvenile onset DM  Depending on insulin injections  insulin dependent DM  non insulin dependent DM  NOW we have other classification 
  • 7. Type I DM  Type II DM  Impaired glucose tolerance I G T  Impaired fasting glucose I F G  Gestational diabetes 
  • 8. Type I, juvenile, IDDM Genetically determined 8 %  Usually start in young  There is no insulin in patient’s blood  Glucagon is high  Pancreatic B-cells are non responsive 
  • 9. Type II, adult, NIDDM Milder  80 %  Usually start in adults  There are enough insulin  usually don’t need exogenous insulin 
  • 10.     May be duo to lack of insulin receptors in peripheral tissues It is divided into Non obese type Obese type
  • 11. Non obese obese
  • 12. Diabetes Signs & Symptoms  *Polydypsia *Marked irritability  *Polyuria *Polyphagia *Loss of weight *Loss of strength *Recurrence of bed wetting *Drowsiness *Malaise      Type 1: the onset of symptoms is sudden Type 2: The onset of symptoms is slow
  • 13. Diagnosis of Diabetes Mellitus  Unequivocal elevation of plasma glucose > 140 mg/dl at least two separate occasions after overnight fasting.  Glucose tolerance test: Considered positive if plasma glucose conc. is 200mg/dl or higher, 2 hrs after giving 75g glucose orally. Pts should be tested in the morning after 3 days of unrestricted CHO diet and normal physical activity.
  • 14. Diagnosis of Diabetes Mellitus  3. Urine sugar.  4. Test paper strips: strips available for direct estimation of blood glucose levels. Blood obtained by finger prick is applied directly to strip, which is washed 1 minute later. The subsequent colour change is compared to a standard chart to determine plasma glucose concentration.
  • 15. complication Acute complications Hypoglycemic coma….more acute& danger Hyperglycemic coma….less acute & ??  chronic complications Affecting large bl vessels------arteriosclerosis Affecting small bl vessels--- microangiopathy Affecting interstitial tissue…..incr. infections 
  • 16. Affecting large bl vessels ------ arteriosclerosis Affecting small bl vessels --- microangiopathy Affecting interstit tissue …. infections
  • 17. Oral Complications & Manifestations  Poorly controlled diabetes:  Xerostomia Bacterial, viral & fungal infection (Candidiasis) Poor wound healing Increase incidence of caries, gingivitis, & periodontal disease, periapical abscesses & burning mouth syndrome   
  • 18. Management  Any dental patient who has clear symptoms of diabetes should be referred to a physician for diagnosis & treatment.  Pts with findings that may suggest diabetes: Headache, dry mouth, marked irritability, repeated skin infection, blurred vision, paraesthesia, periodontal abscesses, loss of sensation. In addition to the poly syndrome
  • 19. Management  Therapy must be a highly individual process and usually must continue for the rest of Patients life.  Therapeutic goals for most Patients are to 1. Maintain as close to normal blood glucose levels as possible without repeated episodes of hypoglycemia. 2. Maintain normal body weight. 3. Control hypertension & hyperlipidemia.
  • 20. Medical management   Type 1 Diabetes - Diet & physical activity. - Insulin - Conventional - Multiple injections - Continuous infusion Type 2 Diabetes - Diet & physical activity. - Oral hypoglycemic agents - Insulin plus Oral hypoglycemic agents - Insulin
  • 21. Medical management Oral Antidiabetic (Hypoglycemic) Drugs Class of Drug 1.Sulfonyl ureas - Chlorpropamide - Acetohexamide 2. Biguanides - Metformin 3. -glucosidase inhibitors 4. Thiazolidinediones - Troglitizone Daily Dose Doses/Day 100-500mg 1500mg 1500-2500mg 1 1 1-2 75-300mg 3 400-600mg 1
  • 22. Medical management Types of Insulin Action Duration of Action (hours) Lispro (Humilin) Short acting 1-1.5 Regular Rapid 4-6 NPH Intermediate 6-12 Lente Intermediate 6-12 Protamine Zinc Long 14-24
  • 23. Management     Insulin Shock Patients being treated with insulin must follow their diet closely. If they fail to eat in a normal pattern but continue to take their regular insulin injection, they may experience a hypoglycemic reaction caused by an excess of insulin (insulin shock). Corrected by giving the patients sweetened fruit juice or anything with sugar in it. Patients in the severe stage (unconsciousness) treated with glucose solution IV; glucagon / epinephrine for transient relief.
  • 24. Dental Management 1. Non-Insulin-dependent Patients All dental procedures can be performed with out special precautions, unless complication of diabetes is present. 2. Insulin – controlled Patients a. Usually all dental procedures can be performed. b. Morning appointments best. c. Patients advised to take usual insulin dosage and normal meals on day of dental appointment; information confirmed when patients come for appointment.
  • 25. Dental Management       d. Patients advised to inform dentist if symptoms of insulin reaction occur during dental visit. e. Source of glucose (orange juice, soda) available & given to Patients if symptoms of insulin reaction occur. 3. If extensive surgery needed: - Consult with physician concerning dietary need during post operative period. - Antibiotic prophylaxis for patients with brittle diabetes and with high doses of insulin with chronic states of oral infection.
  • 26. Dental Management          Dental therapy of Patients with Diabetes and acute oral infection Non-insulin controlled Patients may require insulin; consultation with physician. Insulin-controlled Patients - require insulin (increased dose). Patients with brittle diabetes/ Patients with receiving high insulin dosage should have culture (s) taken from infected area for a sensitivity testing. Infections should be treated using standard methods - warm intra oral rinses - I&D - Pulpotomy, pulpectomy, extraction etc. - Antibiotics.
  • 27. Dental Management  Basic aim of treatment is to simultaneously cure the oral infection and respond to the need to regain control of the diabetic condition. Decision making for dental therapy of Patients with diabetes depending on the blood glucose( Glucometer) reading Fasting blood glucose ( Glucometer reading) <70mg/dl defer elective therapy >200mg/dl defer elective therapy; (or) give CHO. give hypoglycemics (or insulin) (or) refer to physician.
  • 28. Hyperglycemia  In hyperglycemia there is syndrome of poly/: poly/urea, poly/dipsia, poly/phagia, blurred vision, pruritus….  Start by nocturnal enuresis with loss of weight  coma
  • 29. Pruritus Hyperglycemia
  • 30. Hypoglycemia  In Early –CNS : hunger, nausea, hyperactive  In Moderate--- adrenaline is released...> sweating, bizarre behavioral patterns  In severe: unconscious, seizures, hypotension & hypothermia  Acute complications are common
  • 31. Hypoglycemia
  • 32. D/D hypoglycemia & hyperglycemia In hypoglycemia onset : rapid [ min] Skin : cold & wet Breath : no odor  In hyperglycemia onset : slow [ hours & days ] Skin : hot & dry Breath : acetone    If still in doubt, give glucose till medical assist DM patient with impaired conscious should be managed as having hypoglycemia until proved otherwise
  • 33. Manag of hypogly a-consc 1- Recognition of hypoglycemia 2- Terminate dental procedures 3- Supine position with feet elevated 4- A, B,C: Asses and perform basic life support as needed 5-Definitive care oral CHO orange juice 6- Recovery observe for at least 1h
  • 34. Manag of hypogly b-unconsc 1- No time for recognition of hypoglycemia 2- Terminate dent procedures 3- Supine position with feet elevated 4- A, B,C: Asses and perform basic life support as needed 5- Definitive care summoning of medical assistance IV CHO 50% dextrose IV or IM 1mg glucagon SC 0.5mg of 1:1000epinephrine 6- Recovery oral CHO after recovery Glucagon injection
  • 35. Manag of hypergly a-consc 1-recognition of hyperglycemia 2-avoid any dental pro & terminate any one
  • 36. Manag of hypergly b-unconsc 1- Identify the case 2- Terminate dent procedures 3- Supine position with feet elevated 4- A, B,C: Asses and perform basic life support as needed 5- Definitive care Summoning of medical assistance IV CHO 5% dextrose ?? insulin in emergency [with monitoring blood glucose give O2 6- Transport to hospital
  • 37. Medical Alert bracelet and necklace
  • 38. Check list
  • 39. ‫أحد حارات دمشق القديمة‬ ‫دمشق في العام 3091 في‬ ‫مرحلة االحتالل العثماني‬