SlideShare a Scribd company logo
1 of 30
Download to read offline
1
Diabetes mellitus
is a syndrome of disordered metabolism, usually
due to a combination of hereditary and
environmental causes, resulting in abnormally
high blood sugar levels (hyperglycemia).
often referred to simply as diabetes ( Greek: to
pass through <urine>).
2
Normal Glucose Metabolism
the sugars and starches within the foods we eat are
broken down into glucose, and are absorbed into the
blood stream. This absorption causes a rise in the
blood glucose level.
As the blood containing elevated glucose levels
circulates, it comes into contact with the pancreas, and
certain other specific parts of the pancreas, which are
contained in a sub structure called the islets of
Langerhans.
These other specialized parts are the alpha, beta, and
delta cells, which produce particular homones, which
drastically affect blood sugar levels.
3
When an inreased blood sugar level is sensed
by the beta cells, they secrete insulin directly
into the bloodstream. Insulin is a powerful
hormone which allows cell membranes to
change, (become more permeable to glucose),
so that they allow the glucose molecule to be
pulled into the cell interior, where it can be
broken down into energy.
4
In another example, when you've just gotten
done with a bunch of work, and your blood
sugar level begins to fall, the other type of cell,
the alpha cell, senses a low blood sugar
condition, and it releases another hormone,
called glucagone. Glucagone goes out into the
blood stream in the same fashion as the insulin
did, however, the glucagone tells the liver cells
to release some of their stored sugars back
into the blood stream, thus raising the blood
sugar levels back into an operating range.
5
Insulin is also the principal control signal for
conversion of glucose to glycogen for internal
storage in liver and muscle cells. Lowered glucose
levels result both in the reduced release of insulin
from the beta cells and in the reverse conversion of
glycogen to glucose when glucose levels fall. This is
mainly controlled by the hormone glucagon which
acts in an opposite manner to insulin. Glucagon and
insulin are part of a feedback system that keeps
blood glucose levels at a stable level.
Glucose thus recovered by the liver re-enters the
bloodstream; muscle cells lack the necessary export
mechanism.
6
When energy is required, glycogen stores in
the liver are converted into glucose via
glycogenolysis, elevating blood glucose levels
and providing the needed cellular energy
source.
The liver also produces glucose from fat (fatty
acids) and proteins (amino acids) through the
process of gluconeogenesis. Glycogenolysis
and gluconeogenesis both serve to increase
blood glucose levels. Thus, glycemia is
controlled by a complex interaction between
the gastrointestinal tract, the pancreas, and
the liver.
7
Multiple hormones may affect glycemia.
Insulin is the only hormone that lowers
blood glucose levels. The counter-
regulatory hormones such as glucagon,
catecholamines, growth hormone, thyroid
hormone, and glucocorticoids all act to
increase blood glucose levels, in addition
to their other effects .
8
Abnormal Glucose Metablolism
The destruction of beta cells by a virus or an auto-immune
response from our own bodies, are two reasons which
have so far been found for beta cell destruction in clinical
studies.
When this sort of destruction occurs, it impairs the body's
ability to manufacture insulin. In the case of someone with
type 1, insulin-dependent diabetes, the beta cell
destruction may be complete and may never be repaired
by the body. In the case of type 2 diabetes, some beta
cells remain, however they may not be able to keep up
with the body's demand for insulin unless a low
carbohydrate or complex carbohydrate diet is followed.
9
Other conditions
Steroid diabetes(also "steroid-induced diabetes") is a medical term
referring to prolonged hyperglycemia due to glucocorticoid therapy
for another medical condition. It is usually, but not always, a
transient condition.
The most common glucocorticoids which cause steroid diabetes are
prednisolone and dexamethasone given systemically in
"pharmacologic doses" for days or weeks. Typical medical
conditions in which steroid diabetes arises during high-dose
glucocorticoid treatment include severe asthma,
organ transplantation, cystic fibrosis, inflammatory bowel disease,
and induction chemotherapy for leukemia or other cancers.
Topical steroids can also cause hyperglycemia if used in large
quantities and high doses over prolonged time periods, but this
usually resolves with discontinuation of the medication.
10
Types of Diabetes
• Type 1 diabetes. results from autoimmune destruction
of insulin-producing beta cells of the pancreas.
• Type 2 diabetes: The bodyproduces insulin, but the
cells have developed a resistance to it, often because
the pt is overweight or obese. Watching fat intake is a
necessary part of losing weight and keeping diabetes
under control.
• Gestational diabetes. It usually develops during the
third trimester and significantly increases perinatal
morbidity and mortality. the pathophysiology of
gestational diabetes is associated with increased insulin
resistance.
11
Impaired Glucose Tolerance and Impaired
Fasting Glucose
The conditions known as impaired glucose tolerance (IGT) and
impaired fasting glucose (IFG) represent metabolic states
lying between diabetes and normoglycemia. People with IFG
have increased fasting blood glucose levels but usually have
normal levels following food consumption.
they are risk factors for future diabetes. Pathophysiology of
IFG and IGT is related primarily to increased insulin
resistance whereas endogenous insulin secretion is normal
in most patients. Approximately 30 to 40% of individuals with
IGT or IFG will develop type 2 diabetes within 10 years after
onset.
12
Diabetes and Fat Intake
people with diabetes need to limit their fat intake to
decrease their risk of developing heart disease.That is
diabetes slowly damages the arteries in the body
unless blood sugar is very tightly controlled.
The increased risk of cardiovascular disease exists no
matter which of the three types of diabetes the pt has.
Obesity contributes greatly to insulin resistance, even in
the absence of diabetes. In fact, weight loss is a
cornerstone of therapy for obese type 2 diabetic
patients. Insulin resistance generally decreases with
weight loss.
13
There is some evidence that fat cells are more
resistant to insulin than muscle cells. If a person
has more fat cells than muscle cells, then the
insulin becomes less effective overall, and
glucose remains circulating in the blood instead
of being taken in to the cells to be used as
energy.
14
Why Do Type 1 Diabetes Patients Slim Down Even
Eating Much
Due to the fact that Type 1 Diabetes patients lack insulin in
body, patients’ body cannot make the best of glucose. This
stimulates protein and fat in body to acceleratory
decomposition, which contributes to supplying energy and
heat for body. By this, large quantity of carbohydrate,
protein and fat will be consumed. Besides, Type 1 Diabetes
patients are always in a state of water loss; even they have
had more water. when the sugar levels are high, they will
want to pass urine quite a few times. This will naturally
result in dehydration. The loss of sugar in the urine means a
loss of calories which provide energy and therefore many
people with high sugars lose weight.
15
Polyuria,polydipsia,polyphagia
When the glucose concentration in the blood is raised
beyond the renal threshold, reabsorption of glucose in
the proximal renal tubuli is incomplete, and part of the
glucose remains in the urine ( glycosuria). This increases
the osmotic pressure of the urine and inhibits the
reabsorption of water by the kidney, resulting in
increased urine production ( polyuria) and increased fluid
loss. Lost blood volume will be replaced osmotically from
water held in body cells, causing dehydration and
increased thirst(polydipsia).
16
reason for polyphagia is the intracellular
starvation. As in diabetes either there is absence
or the resistance to insulin action so glucose
cannot move into the cells and thus cells are
starved of glucose.
17
Permanent Teeth Erupt Early in Diabetic
Children
The reasons for the speedier tooth eruption may have to do
with gum inflammation, which tended to be greater in
children with diabetes. Gum inflammation may diminish the
mass of the bones supporting the teeth, shortening the
distance that developing teeth need to progress to break
through the gums. This could potentially increase their risk
of dental problems liket they could raise the odds of
misaligned or crowded teeth, which, lead to cosmetic
effects, and can make it harder to clean the teeth and keep
the gums healthy.
Clinical differentiation between
hypoglycemia and hyperglycemia
hypoglycemia
• hunger and weakness followed
bysweating.
• Rapid pulse
• Shakiness, dizziness,
weakness
• Decreased coordination
• Difficulty concentrating
• Blurred vision
• Headache
• Trouble performing routine
tasks
• Note: Symptoms can vary
from person to person and
episode to episode.
hyperglycemia
• Warm, dry skin that does not
sweat
• Dry, parched mout
• Extreme thirst
• Frequent urination
• General weakness
• Loss of appetite
• Fruity breath
• Nausea and vomiting
• Abdominal pain
• Deep, rapid breathing
• High fever
19
Diabetic ketoacidosis
People with type 1 diabetes are highly susceptible to diabetic
ketoacidosis. Because the pancreas produces no insulin, glucose
cannot enter cells and remains in the bloodstream. To meet cellular
energy needs, fat is broken down through lipolysis, releasing
glycerol and free fatty acids. Glycerol is converted to glucose for
cellular use. Fatty acids are converted to ketones, resulting in
increased ketone levels in body fluids and decreased hydrogen ion
concentration (pH). Ketones are excreted in the urine, accompanied
by large amounts of water. The accumulation of ketones in body
fluids, decreased pH, electrolyte loss and dehydration from
excessive urination, and alterations in the bicarbonate buffer system
result in diabetic ketoacidosis (DKA). Untreated DKA can result in
coma or death.
20
Many patients with type 1 diabetes are initially
diagnosed with the disease following a hospital
admission for DKA. In a known diabetic patient,
periods of stress or infection may precipitate DKA.
More often, however, DKA results from poor daily
glycemic control. Patients who remain severely
hyperglycemic for several days or longer due to
inadequate insulin administration or excessive
glucose intake are prone to developing DKA.
21
ORAL COMPLICATIONS OF DIABETES
• Gingivitis and periodontal disease.
• Salivary gland dysfunction and xerostomia.
• Candidiasis.
• Burning mouth syndrome.
• Lichen planus.
• Acute oral infections
• delayed wond healing
• Early tooth loss in IDDM.
22
Gingivitis and periodontal disease
Is related to the altered response to infection,
microvascular changes and, possibly, increased
glucose concentrations in the saliva (salivary
hyperglycemia) and gingival crevicular fluid.
Increased salivary glucose results in additional
bacterial substrate and plaque formation.29
Increased gingival crevicular fluid glucose may
diminish the ability of periodontal fibroblasts to
contribute to periodontal healing.
23
Salivary gland dysfunction and xerostomia.
Is due to polyuria, or an underlying metabolic or endocrine
problem. When the normal environment of the oral cavity is
altered because of a decrease in salivary flow or alteration
in salivary composition, a healthy mouth can become
susceptible to dental caries and tooth deterioration. Dry,
atrophic and cracking oral mucosa is the eventual
complication from insufficient salivary production.
Accompanying mucositis, ulcers and desquamation, as well
as an inflamed, depapillated tongue, are also common
problems. Difficulty in lubricating, masticating, tasting and
swallowing are among the most devastating complications
from salivary dysfunction and may contribute to impaired
nutritional intake.
24
Candidiasis
Salivary dysfunction, compromised immune function
and salivary hyperglycemia that provides a potential
substrate for fungal growth are the major
contributing factors for oral candidiasis in patients
with diabetes. Oral lesions associated with
candidiasis include median rhomboid glossitis
atrophic glossitis, denture stomatitis, (thrush) and
angular cheilitis.
25
Mechanism of increased risk of
infection
• Macrophage metabolism alteration occurs, with inhibition of
phagocytosis.
• Immunological defect and deficient leucocytes functions.
Functions of immune cells, including neutrophil, monocytes and
macrophages are altered.
• Decrease production of antibodies.
• Peripheral neuropathy and poorperipheral circulation.
• All steps of PMN functioning which include PMN chemotaxis,
spontaneous activation of PMN cells, increased free radical
production; after stimulation are altered, which may increase
the risk of vascularcomplications and infectious episodes.
• Neutrophil adherence, chemotaxis and phagocytosis are also
impaired thus inhibiting bacteria killing.
Infection is a possible consequence of
wounds that remain open for an
extended period to time. Another
complication of poorly controlled
diabetes is a decreased immune
response. So diabetes makes
infections both more likely to occur and
harder for the body to fight off.
27
DELAYED HEALING OF WOUNDS
• Microangiopathy and utilization
of protein for energy may retardthe repair of tissues.
• There is altered cellular activities and failure of
PMNs to migrate toward the area ofwound
healing.
• Collagen synthesis isdecreased. Decreased
crosslinking and glycosylation of collagenrenders
collagen produced inDM more soluble and
possiblywith a decrease remodelingtime.
28
Burning mouth syndrome
in uncontrolled or marginally controlled diabetes,
these etiologic factors can include salivary
dysfunction, candidiasis and neurological
abnormalities such as depression. Neuropathy
may lead to oral symptoms of paresthesias and
tingling, numbness, burning or pain caused by
pathological changes involving the nerves in the
oral region.
29
30

More Related Content

What's hot

Pathophysiology of diabetes final 2
Pathophysiology of diabetes final 2Pathophysiology of diabetes final 2
Pathophysiology of diabetes final 2MEEQAT HOSPITAL
 
Pathophysiology of diabetes
Pathophysiology of diabetes Pathophysiology of diabetes
Pathophysiology of diabetes SairamyaLibra
 
Diabetes Mellitus and its types
Diabetes Mellitus and its types Diabetes Mellitus and its types
Diabetes Mellitus and its types Fatima Rahat
 
All what you have to know about Diabetes Mellitus
All what you have to know about Diabetes MellitusAll what you have to know about Diabetes Mellitus
All what you have to know about Diabetes MellitusYapa
 
IVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUS
IVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUSIVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUS
IVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUSImhotep Virtual Medical School
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitusEkta Patel
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes MellitusRatheesh R
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes MellitusJack Frost
 
Diabetus mellitus (seminor)
Diabetus mellitus (seminor) Diabetus mellitus (seminor)
Diabetus mellitus (seminor) ROMAN BAJRANG
 
ueda2011 pathophysiology of dm-d.adel
ueda2011 pathophysiology of dm-d.adelueda2011 pathophysiology of dm-d.adel
ueda2011 pathophysiology of dm-d.adelueda2015
 
Diabetes mellitus-overview
Diabetes mellitus-overviewDiabetes mellitus-overview
Diabetes mellitus-overviewANDREA TITUS
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitusReynel Dan
 
Diabetes mellitus , Risk Factors, Classification, Treatment.
Diabetes mellitus , Risk Factors, Classification, Treatment.Diabetes mellitus , Risk Factors, Classification, Treatment.
Diabetes mellitus , Risk Factors, Classification, Treatment.DR .PALLAVI PATHANIA
 
Diabetes mellitus in children; types, pathophysiology and diagnosis
Diabetes mellitus  in children; types, pathophysiology and diagnosisDiabetes mellitus  in children; types, pathophysiology and diagnosis
Diabetes mellitus in children; types, pathophysiology and diagnosisJoyce Mwatonoka
 

What's hot (20)

Pathophysiology of diabetes final 2
Pathophysiology of diabetes final 2Pathophysiology of diabetes final 2
Pathophysiology of diabetes final 2
 
Pathophysiology of diabetes
Pathophysiology of diabetes Pathophysiology of diabetes
Pathophysiology of diabetes
 
DIABETES MELLITUS
DIABETES MELLITUS DIABETES MELLITUS
DIABETES MELLITUS
 
Diabetes Mellitus and its types
Diabetes Mellitus and its types Diabetes Mellitus and its types
Diabetes Mellitus and its types
 
All what you have to know about Diabetes Mellitus
All what you have to know about Diabetes MellitusAll what you have to know about Diabetes Mellitus
All what you have to know about Diabetes Mellitus
 
IVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUS
IVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUSIVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUS
IVMS Endocrine Part III-PATHOPHYSIOLOGY OF DIABETES MELLITUS
 
Diabetes ppt
Diabetes pptDiabetes ppt
Diabetes ppt
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitus
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Pathophysiology of diabetes by Dr Shahjada Selim
Pathophysiology of diabetes by Dr Shahjada SelimPathophysiology of diabetes by Dr Shahjada Selim
Pathophysiology of diabetes by Dr Shahjada Selim
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Diabetus mellitus (seminor)
Diabetus mellitus (seminor) Diabetus mellitus (seminor)
Diabetus mellitus (seminor)
 
ueda2011 pathophysiology of dm-d.adel
ueda2011 pathophysiology of dm-d.adelueda2011 pathophysiology of dm-d.adel
ueda2011 pathophysiology of dm-d.adel
 
Diabetes mellitus-overview
Diabetes mellitus-overviewDiabetes mellitus-overview
Diabetes mellitus-overview
 
Dm
DmDm
Dm
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitus
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitus
 
Diabetes mellitus , Risk Factors, Classification, Treatment.
Diabetes mellitus , Risk Factors, Classification, Treatment.Diabetes mellitus , Risk Factors, Classification, Treatment.
Diabetes mellitus , Risk Factors, Classification, Treatment.
 
Diabetes mellitus in children; types, pathophysiology and diagnosis
Diabetes mellitus  in children; types, pathophysiology and diagnosisDiabetes mellitus  in children; types, pathophysiology and diagnosis
Diabetes mellitus in children; types, pathophysiology and diagnosis
 
Diabetes pathology
Diabetes pathologyDiabetes pathology
Diabetes pathology
 

Viewers also liked

Occupational Hazards in Dentistry
Occupational Hazards in DentistryOccupational Hazards in Dentistry
Occupational Hazards in Dentistrysplendidlight
 
Solutions for Failing Outsourcing and Offshoring Projects
Solutions for Failing Outsourcing and Offshoring ProjectsSolutions for Failing Outsourcing and Offshoring Projects
Solutions for Failing Outsourcing and Offshoring ProjectsSonja Uhl
 
интегрированный урок игра 2013-2014
интегрированный урок игра 2013-2014интегрированный урок игра 2013-2014
интегрированный урок игра 2013-2014Demanessa
 
Animasi pada-presentasi (1) call uhamka
Animasi pada-presentasi (1) call uhamkaAnimasi pada-presentasi (1) call uhamka
Animasi pada-presentasi (1) call uhamkaking_of_natsir
 
רותם וברוך מטלה שניה
רותם וברוך מטלה שניהרותם וברוך מטלה שניה
רותם וברוך מטלה שניהShahar Akam
 
Crimes and punishments
Crimes and punishmentsCrimes and punishments
Crimes and punishmentsAdlee35
 
Colección Noche 2009 - Astrid A Urban Afrowear
Colección Noche 2009 - Astrid A Urban AfrowearColección Noche 2009 - Astrid A Urban Afrowear
Colección Noche 2009 - Astrid A Urban AfrowearUrbanAfrowear
 
регламент работы на сайте
регламент работы на сайтерегламент работы на сайте
регламент работы на сайтеDemanessa
 
Sensible Solutions for Leases During Challenging Times
Sensible Solutions for Leases During Challenging TimesSensible Solutions for Leases During Challenging Times
Sensible Solutions for Leases During Challenging TimesBuilding Engines
 
Monomios y polinomios
Monomios y polinomiosMonomios y polinomios
Monomios y polinomiosMalenny01
 
Дополненная Реальность
Дополненная Реальность Дополненная Реальность
Дополненная Реальность Hyppolite Panin
 
05 text yudhoyono_13 oct
05 text yudhoyono_13 oct05 text yudhoyono_13 oct
05 text yudhoyono_13 octjhenri5
 

Viewers also liked (20)

Occupational Hazards in Dentistry
Occupational Hazards in DentistryOccupational Hazards in Dentistry
Occupational Hazards in Dentistry
 
Solutions for Failing Outsourcing and Offshoring Projects
Solutions for Failing Outsourcing and Offshoring ProjectsSolutions for Failing Outsourcing and Offshoring Projects
Solutions for Failing Outsourcing and Offshoring Projects
 
интегрированный урок игра 2013-2014
интегрированный урок игра 2013-2014интегрированный урок игра 2013-2014
интегрированный урок игра 2013-2014
 
Public speaking
Public speakingPublic speaking
Public speaking
 
Animasi pada-presentasi (1) call uhamka
Animasi pada-presentasi (1) call uhamkaAnimasi pada-presentasi (1) call uhamka
Animasi pada-presentasi (1) call uhamka
 
Essentio: Presentatie Beurs
Essentio: Presentatie BeursEssentio: Presentatie Beurs
Essentio: Presentatie Beurs
 
רותם וברוך מטלה שניה
רותם וברוך מטלה שניהרותם וברוך מטלה שניה
רותם וברוך מטלה שניה
 
Crimes and punishments
Crimes and punishmentsCrimes and punishments
Crimes and punishments
 
Gabriela balestero e alexandre melo franco bahia necessidade de quebra do p...
Gabriela balestero e alexandre melo franco bahia   necessidade de quebra do p...Gabriela balestero e alexandre melo franco bahia   necessidade de quebra do p...
Gabriela balestero e alexandre melo franco bahia necessidade de quebra do p...
 
Dierle nunes e a bahia revista iob - renovado paradigma
Dierle nunes e a bahia   revista iob - renovado paradigmaDierle nunes e a bahia   revista iob - renovado paradigma
Dierle nunes e a bahia revista iob - renovado paradigma
 
in.pulso Marketing
in.pulso Marketingin.pulso Marketing
in.pulso Marketing
 
Colección Noche 2009 - Astrid A Urban Afrowear
Colección Noche 2009 - Astrid A Urban AfrowearColección Noche 2009 - Astrid A Urban Afrowear
Colección Noche 2009 - Astrid A Urban Afrowear
 
регламент работы на сайте
регламент работы на сайтерегламент работы на сайте
регламент работы на сайте
 
Sensible Solutions for Leases During Challenging Times
Sensible Solutions for Leases During Challenging TimesSensible Solutions for Leases During Challenging Times
Sensible Solutions for Leases During Challenging Times
 
Monomios y polinomios
Monomios y polinomiosMonomios y polinomios
Monomios y polinomios
 
Дополненная Реальность
Дополненная Реальность Дополненная Реальность
Дополненная Реальность
 
Sprint review
Sprint reviewSprint review
Sprint review
 
Doc2
Doc2Doc2
Doc2
 
Comp3
Comp3Comp3
Comp3
 
05 text yudhoyono_13 oct
05 text yudhoyono_13 oct05 text yudhoyono_13 oct
05 text yudhoyono_13 oct
 

Similar to Diabetes mellitus part 1

Similar to Diabetes mellitus part 1 (20)

diabetes & perio
 diabetes & perio diabetes & perio
diabetes & perio
 
Diabetes Mellitus.pptx
Diabetes Mellitus.pptxDiabetes Mellitus.pptx
Diabetes Mellitus.pptx
 
Fuel homeostasis
Fuel homeostasisFuel homeostasis
Fuel homeostasis
 
Diabetes mellitus by Dr. Bhavishath Shetty
Diabetes mellitus by Dr. Bhavishath ShettyDiabetes mellitus by Dr. Bhavishath Shetty
Diabetes mellitus by Dr. Bhavishath Shetty
 
diabetes mellitus & their complications
diabetes mellitus & their complicationsdiabetes mellitus & their complications
diabetes mellitus & their complications
 
Diabetes symptom
Diabetes  symptomDiabetes  symptom
Diabetes symptom
 
Diabetes symptom
Diabetes  symptomDiabetes  symptom
Diabetes symptom
 
Endocrine disorder Diabetes Mellitus (DM)
Endocrine disorder   Diabetes Mellitus (DM) Endocrine disorder   Diabetes Mellitus (DM)
Endocrine disorder Diabetes Mellitus (DM)
 
Diabetes mellitus with complication
Diabetes mellitus with complicationDiabetes mellitus with complication
Diabetes mellitus with complication
 
Diabetes Mellitus (DM)
Diabetes Mellitus (DM)Diabetes Mellitus (DM)
Diabetes Mellitus (DM)
 
Lesson plan of teaching and learning.pptx
Lesson plan of teaching and learning.pptxLesson plan of teaching and learning.pptx
Lesson plan of teaching and learning.pptx
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Diabetes
DiabetesDiabetes
Diabetes
 
DM.pptx
DM.pptxDM.pptx
DM.pptx
 
DIABETES.BIO.pptx
DIABETES.BIO.pptxDIABETES.BIO.pptx
DIABETES.BIO.pptx
 
DIABETES MELLITUS PRESENTATION.pptx
DIABETES MELLITUS  PRESENTATION.pptxDIABETES MELLITUS  PRESENTATION.pptx
DIABETES MELLITUS PRESENTATION.pptx
 
The Patient With Diabetes Mellitus
The Patient With Diabetes MellitusThe Patient With Diabetes Mellitus
The Patient With Diabetes Mellitus
 
Yoga for diabetes and obesity 2010
Yoga for diabetes and obesity 2010Yoga for diabetes and obesity 2010
Yoga for diabetes and obesity 2010
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Diabetes pathology
Diabetes pathologyDiabetes pathology
Diabetes pathology
 

More from splendidlight

Diabetes mellitus part 2
Diabetes mellitus part 2Diabetes mellitus part 2
Diabetes mellitus part 2splendidlight
 
the most used dental instruments in dental operative and teeth filling.
the most used dental instruments in dental operative and teeth filling.the most used dental instruments in dental operative and teeth filling.
the most used dental instruments in dental operative and teeth filling.splendidlight
 
the most used dental instruments in dental clinic
the most used dental instruments in dental clinicthe most used dental instruments in dental clinic
the most used dental instruments in dental clinicsplendidlight
 
Drug prescription in dentistry
Drug prescription in dentistryDrug prescription in dentistry
Drug prescription in dentistrysplendidlight
 
Clinical endodontics (treatment)
Clinical endodontics (treatment)Clinical endodontics (treatment)
Clinical endodontics (treatment)splendidlight
 
Prophylactic antibiotic coverage in dentistry
Prophylactic antibiotic coverage in dentistryProphylactic antibiotic coverage in dentistry
Prophylactic antibiotic coverage in dentistrysplendidlight
 
Personal protective clothing for dentists
Personal protective clothing for dentistsPersonal protective clothing for dentists
Personal protective clothing for dentistssplendidlight
 
دليل الأم لصحة الفم والأسنان
دليل الأم لصحة الفم والأسناندليل الأم لصحة الفم والأسنان
دليل الأم لصحة الفم والأسنانsplendidlight
 

More from splendidlight (11)

Mg
MgMg
Mg
 
Diabetes mellitus part 2
Diabetes mellitus part 2Diabetes mellitus part 2
Diabetes mellitus part 2
 
Dry socket ac
Dry socket acDry socket ac
Dry socket ac
 
the most used dental instruments in dental operative and teeth filling.
the most used dental instruments in dental operative and teeth filling.the most used dental instruments in dental operative and teeth filling.
the most used dental instruments in dental operative and teeth filling.
 
the most used dental instruments in dental clinic
the most used dental instruments in dental clinicthe most used dental instruments in dental clinic
the most used dental instruments in dental clinic
 
Wedges
WedgesWedges
Wedges
 
Drug prescription in dentistry
Drug prescription in dentistryDrug prescription in dentistry
Drug prescription in dentistry
 
Clinical endodontics (treatment)
Clinical endodontics (treatment)Clinical endodontics (treatment)
Clinical endodontics (treatment)
 
Prophylactic antibiotic coverage in dentistry
Prophylactic antibiotic coverage in dentistryProphylactic antibiotic coverage in dentistry
Prophylactic antibiotic coverage in dentistry
 
Personal protective clothing for dentists
Personal protective clothing for dentistsPersonal protective clothing for dentists
Personal protective clothing for dentists
 
دليل الأم لصحة الفم والأسنان
دليل الأم لصحة الفم والأسناندليل الأم لصحة الفم والأسنان
دليل الأم لصحة الفم والأسنان
 

Recently uploaded

Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 

Recently uploaded (20)

Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 

Diabetes mellitus part 1

  • 1. 1
  • 2. Diabetes mellitus is a syndrome of disordered metabolism, usually due to a combination of hereditary and environmental causes, resulting in abnormally high blood sugar levels (hyperglycemia). often referred to simply as diabetes ( Greek: to pass through <urine>). 2
  • 3. Normal Glucose Metabolism the sugars and starches within the foods we eat are broken down into glucose, and are absorbed into the blood stream. This absorption causes a rise in the blood glucose level. As the blood containing elevated glucose levels circulates, it comes into contact with the pancreas, and certain other specific parts of the pancreas, which are contained in a sub structure called the islets of Langerhans. These other specialized parts are the alpha, beta, and delta cells, which produce particular homones, which drastically affect blood sugar levels. 3
  • 4. When an inreased blood sugar level is sensed by the beta cells, they secrete insulin directly into the bloodstream. Insulin is a powerful hormone which allows cell membranes to change, (become more permeable to glucose), so that they allow the glucose molecule to be pulled into the cell interior, where it can be broken down into energy. 4
  • 5. In another example, when you've just gotten done with a bunch of work, and your blood sugar level begins to fall, the other type of cell, the alpha cell, senses a low blood sugar condition, and it releases another hormone, called glucagone. Glucagone goes out into the blood stream in the same fashion as the insulin did, however, the glucagone tells the liver cells to release some of their stored sugars back into the blood stream, thus raising the blood sugar levels back into an operating range. 5
  • 6. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in an opposite manner to insulin. Glucagon and insulin are part of a feedback system that keeps blood glucose levels at a stable level. Glucose thus recovered by the liver re-enters the bloodstream; muscle cells lack the necessary export mechanism. 6
  • 7. When energy is required, glycogen stores in the liver are converted into glucose via glycogenolysis, elevating blood glucose levels and providing the needed cellular energy source. The liver also produces glucose from fat (fatty acids) and proteins (amino acids) through the process of gluconeogenesis. Glycogenolysis and gluconeogenesis both serve to increase blood glucose levels. Thus, glycemia is controlled by a complex interaction between the gastrointestinal tract, the pancreas, and the liver. 7
  • 8. Multiple hormones may affect glycemia. Insulin is the only hormone that lowers blood glucose levels. The counter- regulatory hormones such as glucagon, catecholamines, growth hormone, thyroid hormone, and glucocorticoids all act to increase blood glucose levels, in addition to their other effects . 8
  • 9. Abnormal Glucose Metablolism The destruction of beta cells by a virus or an auto-immune response from our own bodies, are two reasons which have so far been found for beta cell destruction in clinical studies. When this sort of destruction occurs, it impairs the body's ability to manufacture insulin. In the case of someone with type 1, insulin-dependent diabetes, the beta cell destruction may be complete and may never be repaired by the body. In the case of type 2 diabetes, some beta cells remain, however they may not be able to keep up with the body's demand for insulin unless a low carbohydrate or complex carbohydrate diet is followed. 9
  • 10. Other conditions Steroid diabetes(also "steroid-induced diabetes") is a medical term referring to prolonged hyperglycemia due to glucocorticoid therapy for another medical condition. It is usually, but not always, a transient condition. The most common glucocorticoids which cause steroid diabetes are prednisolone and dexamethasone given systemically in "pharmacologic doses" for days or weeks. Typical medical conditions in which steroid diabetes arises during high-dose glucocorticoid treatment include severe asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease, and induction chemotherapy for leukemia or other cancers. Topical steroids can also cause hyperglycemia if used in large quantities and high doses over prolonged time periods, but this usually resolves with discontinuation of the medication. 10
  • 11. Types of Diabetes • Type 1 diabetes. results from autoimmune destruction of insulin-producing beta cells of the pancreas. • Type 2 diabetes: The bodyproduces insulin, but the cells have developed a resistance to it, often because the pt is overweight or obese. Watching fat intake is a necessary part of losing weight and keeping diabetes under control. • Gestational diabetes. It usually develops during the third trimester and significantly increases perinatal morbidity and mortality. the pathophysiology of gestational diabetes is associated with increased insulin resistance. 11
  • 12. Impaired Glucose Tolerance and Impaired Fasting Glucose The conditions known as impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) represent metabolic states lying between diabetes and normoglycemia. People with IFG have increased fasting blood glucose levels but usually have normal levels following food consumption. they are risk factors for future diabetes. Pathophysiology of IFG and IGT is related primarily to increased insulin resistance whereas endogenous insulin secretion is normal in most patients. Approximately 30 to 40% of individuals with IGT or IFG will develop type 2 diabetes within 10 years after onset. 12
  • 13. Diabetes and Fat Intake people with diabetes need to limit their fat intake to decrease their risk of developing heart disease.That is diabetes slowly damages the arteries in the body unless blood sugar is very tightly controlled. The increased risk of cardiovascular disease exists no matter which of the three types of diabetes the pt has. Obesity contributes greatly to insulin resistance, even in the absence of diabetes. In fact, weight loss is a cornerstone of therapy for obese type 2 diabetic patients. Insulin resistance generally decreases with weight loss. 13
  • 14. There is some evidence that fat cells are more resistant to insulin than muscle cells. If a person has more fat cells than muscle cells, then the insulin becomes less effective overall, and glucose remains circulating in the blood instead of being taken in to the cells to be used as energy. 14
  • 15. Why Do Type 1 Diabetes Patients Slim Down Even Eating Much Due to the fact that Type 1 Diabetes patients lack insulin in body, patients’ body cannot make the best of glucose. This stimulates protein and fat in body to acceleratory decomposition, which contributes to supplying energy and heat for body. By this, large quantity of carbohydrate, protein and fat will be consumed. Besides, Type 1 Diabetes patients are always in a state of water loss; even they have had more water. when the sugar levels are high, they will want to pass urine quite a few times. This will naturally result in dehydration. The loss of sugar in the urine means a loss of calories which provide energy and therefore many people with high sugars lose weight. 15
  • 16. Polyuria,polydipsia,polyphagia When the glucose concentration in the blood is raised beyond the renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine ( glycosuria). This increases the osmotic pressure of the urine and inhibits the reabsorption of water by the kidney, resulting in increased urine production ( polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells, causing dehydration and increased thirst(polydipsia). 16
  • 17. reason for polyphagia is the intracellular starvation. As in diabetes either there is absence or the resistance to insulin action so glucose cannot move into the cells and thus cells are starved of glucose. 17
  • 18. Permanent Teeth Erupt Early in Diabetic Children The reasons for the speedier tooth eruption may have to do with gum inflammation, which tended to be greater in children with diabetes. Gum inflammation may diminish the mass of the bones supporting the teeth, shortening the distance that developing teeth need to progress to break through the gums. This could potentially increase their risk of dental problems liket they could raise the odds of misaligned or crowded teeth, which, lead to cosmetic effects, and can make it harder to clean the teeth and keep the gums healthy.
  • 19. Clinical differentiation between hypoglycemia and hyperglycemia hypoglycemia • hunger and weakness followed bysweating. • Rapid pulse • Shakiness, dizziness, weakness • Decreased coordination • Difficulty concentrating • Blurred vision • Headache • Trouble performing routine tasks • Note: Symptoms can vary from person to person and episode to episode. hyperglycemia • Warm, dry skin that does not sweat • Dry, parched mout • Extreme thirst • Frequent urination • General weakness • Loss of appetite • Fruity breath • Nausea and vomiting • Abdominal pain • Deep, rapid breathing • High fever 19
  • 20. Diabetic ketoacidosis People with type 1 diabetes are highly susceptible to diabetic ketoacidosis. Because the pancreas produces no insulin, glucose cannot enter cells and remains in the bloodstream. To meet cellular energy needs, fat is broken down through lipolysis, releasing glycerol and free fatty acids. Glycerol is converted to glucose for cellular use. Fatty acids are converted to ketones, resulting in increased ketone levels in body fluids and decreased hydrogen ion concentration (pH). Ketones are excreted in the urine, accompanied by large amounts of water. The accumulation of ketones in body fluids, decreased pH, electrolyte loss and dehydration from excessive urination, and alterations in the bicarbonate buffer system result in diabetic ketoacidosis (DKA). Untreated DKA can result in coma or death. 20
  • 21. Many patients with type 1 diabetes are initially diagnosed with the disease following a hospital admission for DKA. In a known diabetic patient, periods of stress or infection may precipitate DKA. More often, however, DKA results from poor daily glycemic control. Patients who remain severely hyperglycemic for several days or longer due to inadequate insulin administration or excessive glucose intake are prone to developing DKA. 21
  • 22. ORAL COMPLICATIONS OF DIABETES • Gingivitis and periodontal disease. • Salivary gland dysfunction and xerostomia. • Candidiasis. • Burning mouth syndrome. • Lichen planus. • Acute oral infections • delayed wond healing • Early tooth loss in IDDM. 22
  • 23. Gingivitis and periodontal disease Is related to the altered response to infection, microvascular changes and, possibly, increased glucose concentrations in the saliva (salivary hyperglycemia) and gingival crevicular fluid. Increased salivary glucose results in additional bacterial substrate and plaque formation.29 Increased gingival crevicular fluid glucose may diminish the ability of periodontal fibroblasts to contribute to periodontal healing. 23
  • 24. Salivary gland dysfunction and xerostomia. Is due to polyuria, or an underlying metabolic or endocrine problem. When the normal environment of the oral cavity is altered because of a decrease in salivary flow or alteration in salivary composition, a healthy mouth can become susceptible to dental caries and tooth deterioration. Dry, atrophic and cracking oral mucosa is the eventual complication from insufficient salivary production. Accompanying mucositis, ulcers and desquamation, as well as an inflamed, depapillated tongue, are also common problems. Difficulty in lubricating, masticating, tasting and swallowing are among the most devastating complications from salivary dysfunction and may contribute to impaired nutritional intake. 24
  • 25. Candidiasis Salivary dysfunction, compromised immune function and salivary hyperglycemia that provides a potential substrate for fungal growth are the major contributing factors for oral candidiasis in patients with diabetes. Oral lesions associated with candidiasis include median rhomboid glossitis atrophic glossitis, denture stomatitis, (thrush) and angular cheilitis. 25
  • 26. Mechanism of increased risk of infection • Macrophage metabolism alteration occurs, with inhibition of phagocytosis. • Immunological defect and deficient leucocytes functions. Functions of immune cells, including neutrophil, monocytes and macrophages are altered. • Decrease production of antibodies. • Peripheral neuropathy and poorperipheral circulation. • All steps of PMN functioning which include PMN chemotaxis, spontaneous activation of PMN cells, increased free radical production; after stimulation are altered, which may increase the risk of vascularcomplications and infectious episodes. • Neutrophil adherence, chemotaxis and phagocytosis are also impaired thus inhibiting bacteria killing.
  • 27. Infection is a possible consequence of wounds that remain open for an extended period to time. Another complication of poorly controlled diabetes is a decreased immune response. So diabetes makes infections both more likely to occur and harder for the body to fight off. 27
  • 28. DELAYED HEALING OF WOUNDS • Microangiopathy and utilization of protein for energy may retardthe repair of tissues. • There is altered cellular activities and failure of PMNs to migrate toward the area ofwound healing. • Collagen synthesis isdecreased. Decreased crosslinking and glycosylation of collagenrenders collagen produced inDM more soluble and possiblywith a decrease remodelingtime. 28
  • 29. Burning mouth syndrome in uncontrolled or marginally controlled diabetes, these etiologic factors can include salivary dysfunction, candidiasis and neurological abnormalities such as depression. Neuropathy may lead to oral symptoms of paresthesias and tingling, numbness, burning or pain caused by pathological changes involving the nerves in the oral region. 29
  • 30. 30