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Chapter 6: Diabetes
1.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diabetes Chapter 6
2.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives • Upon completion of this chapter, you will be able to: – Define diabetes mellitus – Explain the function of insulin – Explain the difference between Type I and Type II diabetes – Define oral hypoglycemics – Explain two possible causes of diabetes 2
3.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (cont’d.) – Define hyperglycemia – Explain the signs and symptoms of hyperglycemia – Explain the treatment of hyperglycemia – Define hypoglycemia – Explain the signs and symptoms of hypoglycemia 3
4.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (cont’d.) – Define glucagon – Explain the difference between diabetic coma and insulin shock – Explain two medical problems associated with diabetes – Describe one dental problem the diabetic may present 4
5.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. History • Diabetes mellitus: a disease of metabolism that occurs as a result of either a deficiency or a complete lack of insulin in the body • Early 1920s: lack of insulin discovered to be the cause of diabetes – Animal insulin used as treatment • 1980s: bioengineered insulin as treatment 5
6.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Functions of Glucose and Insulin • Glucose: fuel for the body from the food we eat – Body has to have glucose to survive • Insulin: a hormone produced by the pancreas – Insulin must be present for glucose to enter cells 6
7.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Functions of Glucose and Insulin (cont’d.) • Patients with diabetes who have to take insulin: – Pancreas is usually not producing insulin or not producing enough insulin • Patients with diabetes who do not have to take insulin: – Pancreas usually produces enough or too much insulin – Problem is the insulin receptors 7
8.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Functions of Glucose and Insulin (cont’d.) • Important that levels of glucose in the blood be kept at appropriate levels – Glucose can be toxic to other tissues – Too much glucose can be as problematic as too little 8
9.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Type I and Type II Diabetes • Type I—Insulin Dependent Diabetes Mellitus (IDDM) – Seen most often in the young • May be known as juvenile diabetes – Associated most often with additional medical problems – Requires daily insulin injections 9
10.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Type I and Type II Diabetes (cont’d.) • Type II—Noninsulin Dependent Diabetes Mellitus (NIDDM) – Occurs most often in obese adults – Usually controlled with diet and/or oral hypoglycemic – Is increasing in younger patients due to the increased obesity levels 10
11.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Type I and Type II Diabetes (cont’d.) • Complications of diabetes can include: – Macrovascular disease – Microvascular disease – Neuropathy • Imbalance of glucose can result in the following conditions: – Hypoglycemia – Hyperglycemia 11
12.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Causes of Diabetes • Most causes are unknown • Theory as to what causes diabetes: – Heredity – Type I diabetes may be caused by a virus related to the mumps that damages cells of the pancreas 12
13.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Causes of Diabetes (cont’d.) – Type II diabetes can be caused by pregnancy, which results in drastic hormonal changes in the body 13
14.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classification • Classified as Type I or Type II • Type I used to be called juvenile diabetes – Also occurs in older people – Type I diabetes is insulin-dependent diabetes – Body does not produce enough insulin – Person must inject insulin or it must be delivered via pump 14
15.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classification (cont’d.) – Majority of medical problems occur with Type I because patient has the disease for so long • Type II diabetes used to be called adult onset – Changed the name because the condition also occurs in the young – Most people with Type II diabetes are middle- aged and obese 15
16.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classification (cont’d.) – Accounts for majority of cases of diabetes – Usually controlled with diet, exercise, and oral hypoglycemics 16
17.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Gestational Diabetes • Forms in pregnancy, ends after delivery • Pregnancy hormones block insulin – Most women produce enough additional insulin to overcome the blocking effect – When the pancreas produces all the insulin it can and there is still not enough, diabetes develops – When the placenta’s hormones are removed after delivery, diabetes ends 17
18.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Gestational Diabetes (cont’d.) • Some women are at greater risk: – Obese – Family history of diabetes – Having given birth previously to a very large infant – Stillbirth, or a child with a birth defect – Having too much amniotic fluid – Older than 25 18
19.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Hypoglycemics • Medications that lower blood sugar • Not effective for Type I diabetes • Best to first try to treat with diet and exercise • Not used with pregnant patients or patients with kidney or liver problems 19
20.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diabetic Emergencies: Hyperglycemia and Hypoglycemia • Hyperglycemia: too much blood glucose • Hypoglycemia: too little blood glucose • Both of these can develop into an emergency situation 20
21.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperglycemia • Occurs when there is too much glucose (sugar) in the blood – Usually seen when there is a deficiency or lack of insulin – Slow occurring condition – Patient exhibits increased urination and thirst 21
22.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperglycemia (cont’d.) – May also exhibit loss of appetite, nausea and/or vomiting, fatigue, abdominal pains, and generalized aches • If condition is allowed to progress, patient will exhibit Kussmaul breathing (heavy, labored breathing) – Patient’s breath will have a fruity, acetone odor 22
23.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperglycemia (cont’d.) • Without treatment, patient could lose consciousness and die – Diabetic coma: now rare as symptoms are identifiable for several days prior • People experiencing hyperglycemia require insulin injections 23
24.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperglycemia (cont’d.) • If unconscious, patient should be transported to a medical facility by medical transport • Dental staff should not inject insulin into an unconscious patient as the amount needed is unknown 24
25.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hypoglycemia • Also known as insulin shock • Occurs as a result of too little glucose in the body • Usually has rapid onset and caused by: – Skipping a meal • Ask patient when they last ate a meal – Unusual amount of exercise – Change in routine 25
26.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hypoglycemia (cont’d.) • Person may exhibit: – Cold sweat and appear nervous, trembling, weak, hungry – Personality change, including irritability, confusion, and the inability to think clearly • Patient may appear upset and refuse treatment 26
27.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hypoglycemia (cont’d.) • Patient requires treatment as soon as possible: – Some type of sugar into the patient • Orange juice – If the patient is unconscious • Administer glucagon by injection – A hormone produced by the pancreas to increase blood sugar • Once patient regains consciousness, orange juice should be administered 27
28.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diabetic Coma or Insulin Shock? • If the type of diabetes is unknown, treat the condition as insulin shock – Administer glucagon – Brain damage can occur quickly without glucose 28
29.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diabetic Coma or Insulin Shock? (cont’d.) – Body can handle large amounts of glucose longer than the brain can survive with low levels of glucose – If recovery does not occur, call EMS 29
30.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Medical Problems • Diabetes increases macrovascular (large- vessel) abnormalities via inadequate blood supply to the: – Heart (myocardial infarction, angina pectoris) – Brain (cerebrovascular accidents) – Legs (infection or tissue necrosis) – Kidneys (dysfunction or failure) 30
31.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Medical Problems (cont’d.) • Diabetes increases microvascular (small- vessel) abnormalities via inadequate blood supply to the: – Eyes • Diabetic retinopathy can cause blindness 31
32.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Manifestations • Patient may experience diabetic coma or insulin shock in the dental office • Dental team may have to alter treatment to avoid a medical emergency • Severe periodontal disease is common among diabetic patients – Even with good oral hygiene habits 32
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©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Manifestations (cont’d.) – Periodontal disease can cause diabetes to be uncontrolled from infection and inflammation • Patients with diabetes are prone to infection • Dental team should: – Maintain a current medical history on each diabetic patient 33
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©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Manifestations (cont’d.) – Consult the patient’s physician for any extensive treatment – Keep the patient calm during procedures – Avoid scheduling appointments during typical mealtimes 34
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©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Manifestations (cont’d.) • Team should understand how to work with patients of different ages with diabetes – Children with diabetes may be concerned about new situations such as a dental appointment 35
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©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Oral Manifestations (cont’d.) – Adolescents may not be monitoring their blood sugar and controlling their diabetes • Could experience a reaction during dental treatment 36
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©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary • Diabetes has only been studied and effectively treated for about 60 years • Remarkable advancements have occurred rapidly • It is hoped that further advancements will alleviate potential diabetic emergencies in the dental office, such as diabetic coma and insulin shock 37
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