diabetic mellitus management for dental student

1. Diabetes
mellitus
By :Mhamad rostam

2. Definition
Epidemiology
Classification
Signs &
symptoms
Predisposing factors
Pathophysiology
Complications
Oral
manifestation
Diagnosis
Treatment &
management
Prognosis
Summary
References
Content

3. Diabetes is a condition where the
body either fail to produce insulin (type
1)or the insulin that’s produced no
longer as effect(type 2 DM)
Definition
Insulin is a hormone produced in the
beta cells of the Islets of Langerhans
within the pancreas. Insulin is
released directly into the bloodstream
and is therefore part of the endocrine
system. • Insulin acts like a key which
allows blood glucose to enter the cells
around the body for use as an energy
supply. • Glucose is essential for the
body to function properly. The brain is
particularly affected by any reduction
in blood glucose supply due to its lack
of capacity for glucose storage.
Diabetic mellitus Insulin

4. Epidemiology● Type 2 DM accounts for 90-95% of all
patients with DM.
● Type 1 DM is four times more prevalent
than type 2 DM in persons younger than
20 years of age.
● It is the fourth or fifth leading cause of
death.
● Obesity is a major factor in the continual
rise
in the number of cases of DM.
● Other factors associated with the increasing
prevalence of diabetes are the increasing
population, increasing life expectancy, and
increasing number of affected persons who
have offspring who will pass on the disease
Prevalence

5. Classification
Type 1 diabetes
01
Type 2 diabetes
02
Other specific types of
diabetes
03
In Gestational diabetes
mellitus
04

6. Pathophysiology

7. In this condition the idiopathic auto immune disease (T cells)
attacks and destroys the insulin producing beta cells of the
pancreas
There is beta cell deficiency leading to complete insulin
deficiency
The destruction may take time but the onset of the disease is
rapid and may occur over a few days to weeks
There may be other autoimmune conditions associated with
type 1 diabetes including vitiligo Addison's diseas
Type 1 diabetes always requires insulin therapy, and will not
respond to insulin-stimulating oral drugs
● Type1

8. This condition is caused by a relative deficiency of insulin
and not an absolute deficiency
Body is unable to produce adequate insulin to meet the
needs, there is Beta cell deficiency coupled with peripheral
insulin resistance
Peripheral insulin resistance means that although blood
levels of insulin are high there is no hypoglycemia or low
blood sugar
In most cases over time the patients need to take insulin
when oral drugs fail to stimulate adequate insulin release
Type 2

9. Gestational diabetes is caused when there are excessive
counter-insulin hormones of pregnancy
This leads to a state of insulin resistance and high blood
sugar in the mother
There may be defective insulin receptors
Gestational diabetes

10. Other specific types of diabetes can be caused by specific ge
ne defects, endocrine conditions such as primary destruction
of islet cells through inflammation, cancer, surgery, hyperpitui
tarism, or hyperthyroidism. Iatrogenic disease that occurs aft
er steroid administration is a known cause
Other specific types of
diabetes mellitus

11. Sign & Symptom
 Polyuria
 Polydipsia
 Polyphagia
 Muscle weakness
 Blurred vision
 Poor wound healing
 Breath odor or an acetone odor
 Numbness and tingling
 Weight loss or gain

12. Predisposing Factor
 Overweight
 Family history of diabetes mellitus
 Hypercholesterolemia
 Physical inactivity
 Gestational diabetes mellitus
 depression
 Age
 Race

13. Complications of diabetes are related to the level
of hyperglycemia and pathologic changes that
occur within the vascular system and the
peripheral nervous system
Both the duration and degree of hyperglycemia
directly relates to frequency and severity of the
complications and morbidity seen in diabetic
patients.
Complication

14. Common Complication
Ketoacidosis
Accelerated atherosclerosis
Stroke
Hypertension
Ulceration and gangrene of feet
Blindness
Diabetic nephropathy
Dehydration
Diabetic neuropathy
Early death
More susceptible to infection
Healing of wounds is delayed
Skin rashes
Coronary insufficiency
Myocardial infarction
Candida

15. Oral Manifestation
1. Xerostomia
2. Bacterial, viral and fungal infections
3. Poor wound healing
4. Increased incidence & severity of caries
5. Gingivitis and periodontal disease
6. Burning mouth symptoms
7. Traumatic ulcers
8. Paresthesia and tingling
9. Numbness
10. Acetone teste
11. Atrophy of the oral mucosa
12. Bilateral sialosis
13. Edentulism

16. Deference between hypo & hyper glycaemia
1. When a blood-sugar (glucose) level get low in
the blood. .
2. High pulse Pale skin Confused state of mind
Anxiety Tantrums. Fast heartbeat Headache
3. Excess of insulin Excessive exercise
4. It damages eyes, kidneys, fits, confusion
5. Hypoglycemia is a sudden outcome
6. When blood glucose level of less than 70-100
mg per deciliter
1. When a blood-sugar (glucose) level rises in
blood
2. Increased thirst (Polydipsia) More urination than
usual (Polyuria) High-volume rapid pulse rate
Hot and dry skin Abdomen pain Vomiting
Drowsiness, fatigue or no energy Weight loss.
3. Too much intake of food The absence of insulin
Stress Side effects of drugs.
4. It may lead to coma, urinary excretion, nerve
damage, unconsciousness, infertility, blurred
vision.
5. Hyperglycemia develops slowly over a long
period When blood glucose level rises above
126 mg per deciliter
Hypoglycemia Hyperglycemia

17. Diagnosis
01
02
03
Specific laboratory findings
Presence of clinical signs and
symptoms

18. Specific laboratory findings
01
Random sampling
03
02
After fasting
04
oral glucose
tolerance test
Glycosylated
hemoglobin
The Hb1Ac can provide
false positive and
negative values in rare
situations, such as
patients with severe iron
deficiency and patients
with any form of
hemoglobinopathy, for
example sickle cell
disease

19. TREATMENT & MANAGEMENT
● Diet & Exercise
● Pancreas or Beta-Islet Cell
Transplantation (only in emerging
conditions)
● Weight control
● Medication

20. TREATMENT & MANAGEMENT
Medication
 Type 1 diabetes
Exogenous insulin via subcutaneous injection
 Type 2 diabetes
Metformin which is first line therapy
Second-line therapy includes the sulfonylureas,
thiazolidinediones, dipeptidyl peptidase-IV (DPP-4)
inhibitors, glucagon-like polypeptide-1 (GLP-1)
agonists, or insulin
Combination Therapy

21. Dental Management
 Taking history
 Type of diabetes should be determined
 Dosage of insulin usage
 Vital signs
 Functional capacity
 Analgesics
 Antibiotics
 Anesthetics
 Consultation
 Diet
 Devices
 Drugs
 Appointment Scheduling

22. Dental Management
Hyperglycemia
Prior to initiating any invasive dental treatments, blood
glucose levels of patients with diabetes should be less
than 200 mg/dL. Consider that the physical and
emotional stress that may occur during treatment can
cause blood glucose levels to rise even higher and
possibly place the patient at risk for a medical
emergency.

23. Dental Management
Hyperglycemia
In addition, uncontrolled diabetes can also be a factor
towards increasing healing time and place the patient at
risk for infection. If the patient has forgotten to take the
recommended dose of their diabetes oral agent and/or
insulin, this can be done and the blood glucose value
retested. Caution the patient not to take more than the
prescribed amount. Also, since blood glucose values will
decrease with activity, the patient could walk around the
office for 15 minutes and be retested. If the blood
glucose level is still above 200 mg/dL, the patient should
be referred to their diabetes healthcare team and the
dental appointment rescheduled. Conducting
noninvasive procedures, such as radiographs or an oral
examination, may be warranted prior to dismissal

24. Dental Management
Hyperglycemia
Blood glucose levels tend to be more stable in the
morning; therefore, morning appointments may be more
beneficial for this patient. Stress reduction techniques,
such as use of headphones, and short appointments
may help keep blood glucose levels from rising
The dental patient with uncontrolled hyperglycemia may
require prophylactic antibiotic therapy. Systemic
antibiotic therapy or topical antimicrobial therapies are
accepted treatment modalities for aggressive treatment
of oral infections. Recare appointments should be at
least every three months to monitor wound healing and
minimize periodontal infection.

25. Dental Management
Hyperglycemia
Since epinephrine antagonizes the action of insulin,
resulting in hyperglycemia, local anesthesia without
vasoconstrictors is recommended when possible for
patients with uncontrolled diabetes. Another
consideration is to use glucocorticosteroids with caution
since they also have the potential to raise blood glucose
level
Dental hygiene management also includes fluoride
therapy for patients with a high caries rate and
recommendations to relieve xerostomia if necessary.
Since a patient with uncontrolled diabetes has an
exaggerated response to plaque, encouragement of
meticulous oral hygiene is essentia

26. Dental Management
Hyperglycemia
Wound infection is a major com-plication in diabetic
patients Factors such as age, obesity, malnutrition, and
microvascular and micro- vascular diseases may
contribute to wound infection and delayed wound healing
especially in the type II diabetic patient. In addition,
hyperglycemia caused by decreased insulin availability
and increased resistance to insulin can affect the cellular
response to tissue injury.

27. Dental Management
Hyperglycemia
At the cellular level, an increase in the number of acute
inflammatory cells, absence of cellular growth, and
migration of the epidermis have been observed Patients
with diabetes
have impaired leukocyte function, and the metabolic
abnormalities of diabetes lead to inadequate migration of
neutrophils and macrophages to the wound, along with
reduced chemotaxis Such cellular changes would
predispose individuals to an increased risk of wound
infection. In order to prevent such complication, frequent
dental visits may help to control plaque formation and to
identify risk factors for periodontal disease, caries and
oral candidiasis use antibiotic and drug contain asprin

28. Dental Management
Emergency Managing Hyperglycemia
Less likely to occur in the dental office since it develops
more slowly than hypoglycemia
Opening the airway, and administering oxygen
Circulation and vital signs should be maintained and
monitored, and the patient should be transported to a
hospital as soon as possible
IV insulin injection

29. Dental Management
Sign and symptom : confusion, sweating, tremors,
agitation, anxiety, dizziness, tingling or numbness,
tachycardia, seizures and consciousness.
Check the blood glucose with a glucometer
Emergency Managing Hypoglycemia

30. Dental Management
If a glucometer is unavailable, the condition should be
treated presumptively as a hypoglycemic episode
Give source of carbohydrate
Administer intravenous, intramuscular, or subcutaneous
glucagon or dextrose
Signs and symptoms of hypoglycemia should resolve in
10 to 15 min, and the patient should be carefully
observed for 30 to 60 min after recovery
A second evaluation with a glucometer should be done
Emergency Managing Hypoglycemia

31. Prognosis of diabetes is good when it is
controlled, if not it causes many complications

32. Diabetes is a disease that occurs when your
blood glucose, also called blood sugar, is too
high. Blood glucose is your main source of
energy and comes from the food you eat. Insulin,
a hormone made by the pancreas, helps glucose
from food get into your cells to be used for energy
Summary

33. Refrence
https://www.everydayhealth.com/hs/
better-type-2-diabetes-control/avoid-
medication-mistakes
https://www.dentalcare.com/en-
us/professional-education/ce-
courses/ce93/hyperglycemia
https://biodifferences.com/difference
-between-hypoglycemia-and-
hyperglycemia.html
burket of oral medicine

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