This document discusses diabetes mellitus (DM), also known as diabetes, which is a group of metabolic diseases involving high blood sugar levels over a prolonged period. There are three main types of DM: type 1 DM results from failure to produce insulin; type 2 DM involves insulin resistance and sometimes lack of insulin production; and gestational DM occurs in pregnant women without prior history of diabetes. Serious long-term complications of DM include heart disease, stroke, kidney failure, foot ulcers, and eye damage. Surgery in diabetic patients requires frequent blood glucose monitoring during and after the procedure, as well as careful management of insulin and oral medications.
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Mellitus is Latin for “sweet as honey”.
Pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.
The Pancreas secretes insulin and Glucagon directly into the blood stream.
It also secretes digestive enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.
Insulin and Glucagon have opposite effects on liver and other tissues for controlling blood-glucose levels.
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Mellitus is Latin for “sweet as honey”.
Pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.
The Pancreas secretes insulin and Glucagon directly into the blood stream.
It also secretes digestive enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.
Insulin and Glucagon have opposite effects on liver and other tissues for controlling blood-glucose levels.
This is a brief discussion on diabetes mellitus as medical emergency that can be encountered in any dental office.
What to do in such conditions is what I've briefly tried to explain over here.
Regards,
Dr. Abhishek Sharma
(M.D.S - 2016 Batch ; Oral & Maxillofacial Surgery)
Nephrotic syndrome happens when damage to your kidneys causes these organs to release too much protein into your urine.
Nephrotic syndrome isn’t itself a disease. Diseases that damage blood vessels in your kidneys cause this syndrome.
Nephrotic syndrome is characterized by the following:
A high amount of protein present in the urine (proteinuria)
high cholesterol and triglyceride levels in the blood (hyperlipidemia)
Low levels of a protein called albumin in the blood (hypoalbuminemia)
Swelling (edema), particularly in your ankles and feet, and around your eyes.
DEFINITION OF DIABETES MELLITUS :
It is the group of metabolic disorders which characterised by hyperglycemia and abnormalities of carbohydrate, fat and protein metabolism. resulting from defects in insulin secretion, insulin action, or. Both .
Causes:-
Life style
Genetics factor
Obesity
Diet time variation
Etiological Classification of Diabetes:
Type :-1 Diabetes (insulin dependent)
Type :-2 Diabetes (non insulin dependent)
Gestational diabetes
DEFINTION OF TYPE 1 DIABETES :
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition by the beta cells in islets of Langerhans in the pancreas in which the pancreas produces little or no insulin, due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.
DEFINITION OF TYPE 2 DIABETES :
known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, due to body cells don’t respond normally to insulin; this is called insulin resistance.
DEFINITION OF GESTATIONAL DIABETES :
Gestational Diabetes: Is the increasing of blood sugar levels for Some women tend to experience high levels of blood glucose as during pregnancy due to reduced sensitivity of insulin receptors.
CAUSES :
The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys cells which the insulin-producing (islets of Langerhans) cells in the pancreas. Other possible causes include:
Genetics
Exposure to viruses and other environmental factors
Endocrine disorders such as acromegaly , Cushing's syndrome
Endocrine disorders e.g. Pancreatitis .
Medications e.g. glucocorticoids , niacin , pentamine alpha- interferons .
Micro vascular complications (zeroplateas , neutrophils , eosinophil's )
Macro vascular complications (CHF , stroke , peripheral vascular disease)
SYMPTOMS :
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
Increased thirst
Frequent urination
Bed-wetting in children who previously didn't wet the bed during the night
Extreme hunger
Unintended weight loss
Irritability and other mood changes
Fatigue and weakness
Blurred vision
PHARMACOLOGICAL TREATMENT :
Insulin:
People with type 1 diabetes must take insulin every day. You usually take the insulin through an injection.
Metformin :
Metformin is a type of oral diabetes medication. For many years, it was only used in people with type 2 diabetes. However, some people with type 1 diabetes can develop insulin resistance. That means the insulin they get from injections doesn’t work as well as it should.
Metformin helps lower sugar in the blood by reducing sugar production in the liver. Your doctor may advise you to take Metformin in addition to insulin.
B) NON- PHARMACOLOGICAL TREATMENT :
CONTROL THE SYMPTOMS .
EXERCISES
MONITORING THE SUGAR LEVELS
HEALTHY FOODS .
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
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This is a brief discussion on diabetes mellitus as medical emergency that can be encountered in any dental office.
What to do in such conditions is what I've briefly tried to explain over here.
Regards,
Dr. Abhishek Sharma
(M.D.S - 2016 Batch ; Oral & Maxillofacial Surgery)
Nephrotic syndrome happens when damage to your kidneys causes these organs to release too much protein into your urine.
Nephrotic syndrome isn’t itself a disease. Diseases that damage blood vessels in your kidneys cause this syndrome.
Nephrotic syndrome is characterized by the following:
A high amount of protein present in the urine (proteinuria)
high cholesterol and triglyceride levels in the blood (hyperlipidemia)
Low levels of a protein called albumin in the blood (hypoalbuminemia)
Swelling (edema), particularly in your ankles and feet, and around your eyes.
DEFINITION OF DIABETES MELLITUS :
It is the group of metabolic disorders which characterised by hyperglycemia and abnormalities of carbohydrate, fat and protein metabolism. resulting from defects in insulin secretion, insulin action, or. Both .
Causes:-
Life style
Genetics factor
Obesity
Diet time variation
Etiological Classification of Diabetes:
Type :-1 Diabetes (insulin dependent)
Type :-2 Diabetes (non insulin dependent)
Gestational diabetes
DEFINTION OF TYPE 1 DIABETES :
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition by the beta cells in islets of Langerhans in the pancreas in which the pancreas produces little or no insulin, due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.
DEFINITION OF TYPE 2 DIABETES :
known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, due to body cells don’t respond normally to insulin; this is called insulin resistance.
DEFINITION OF GESTATIONAL DIABETES :
Gestational Diabetes: Is the increasing of blood sugar levels for Some women tend to experience high levels of blood glucose as during pregnancy due to reduced sensitivity of insulin receptors.
CAUSES :
The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys cells which the insulin-producing (islets of Langerhans) cells in the pancreas. Other possible causes include:
Genetics
Exposure to viruses and other environmental factors
Endocrine disorders such as acromegaly , Cushing's syndrome
Endocrine disorders e.g. Pancreatitis .
Medications e.g. glucocorticoids , niacin , pentamine alpha- interferons .
Micro vascular complications (zeroplateas , neutrophils , eosinophil's )
Macro vascular complications (CHF , stroke , peripheral vascular disease)
SYMPTOMS :
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
Increased thirst
Frequent urination
Bed-wetting in children who previously didn't wet the bed during the night
Extreme hunger
Unintended weight loss
Irritability and other mood changes
Fatigue and weakness
Blurred vision
PHARMACOLOGICAL TREATMENT :
Insulin:
People with type 1 diabetes must take insulin every day. You usually take the insulin through an injection.
Metformin :
Metformin is a type of oral diabetes medication. For many years, it was only used in people with type 2 diabetes. However, some people with type 1 diabetes can develop insulin resistance. That means the insulin they get from injections doesn’t work as well as it should.
Metformin helps lower sugar in the blood by reducing sugar production in the liver. Your doctor may advise you to take Metformin in addition to insulin.
B) NON- PHARMACOLOGICAL TREATMENT :
CONTROL THE SYMPTOMS .
EXERCISES
MONITORING THE SUGAR LEVELS
HEALTHY FOODS .
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
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2. Diabetes mellitus (DM), also known as simply diabetes, is a
group of metabolic diseases in which there are high blood
sugar levels over a prolonged period
3. any one of the following-
• Fasting plasma glucose level ≥ 7.0 mmol/l
(126 mg/dl)
• Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two
hours after a 75 g oral glucose load as in a
glucose tolerance test
• Symptoms of hyperglycemia and casual
plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
• Glycated hemoglobin (Hb A1C) ≥ 6.5%.
4. • Serious long-term complications include heart
disease,
• stroke,
• kidney failure,
• foot ulcers and
• damage to the eyes.
5. • Type 1 DM results from the body's failure to
produce enough insulin. This form was
previously referred to as "insulin-dependent
diabetes mellitus" (IDDM) or "juvenile
diabetes". The cause is unknown.
6. • Type 2 DM begins with insulin resistance, a
condition in which cells fail to respond to
insulin properly. As the disease progresses a
lack of insulin may also develop. This form was
previously referred to as "non insulin-
dependent diabetes mellitus" (NIDDM) or
"adult-onset diabetes". The primary cause is
excessive body weight and not enough
exercise.
7. • Gestational diabetes, is the third main form
and occurs when pregnant women without a
previous history of diabetes develop a high
blood glucose level.
• Type 1 diabetes must be managed
with insulin injections.
• Type 2 diabetes may be treated with
medications with or without insulin.
8. Surgical complications of Diabetes are due to
1) Micro vascular changes involving the
capillaries of retina, kidneys, and peripheral
nerves.
2) Macro vascular changes characterized by
atherosclerotic lesions of the coronary and
peripheral arterial circulation.
3) Diabetic neuropathy.
4) Infection in glucose loaded tissue.
9. Surgical complications in Diabetic
Patient
• Bacterial infections like abscesses, carbuncles,
chronic balanitis, and diabetic foot.
Emphysematous Cholecystitis,
Emphysematous Pyelonephritis, Necrotising
fasciitis and
Fournier’s gangrene
Fungal infections like candidiasis, Mucormycosis.
• Sexual dysfunctions
10.
11. Diabetic foot
• Most feared and devastating complication of
diabetes
• Most common cause for leg amputations
• The classic pathological triad of the diabetic
foot is vascular disease, neuropathy and infection
12. Wagner’s classification for diabetic
foot
• Grade 0 : High risk foot. No ulceration
• Grade 1 : Superficial ulceration
• Grade 2 : Deep ulceration penetrating up to
tendon, bone or joint
• Grade 3 : Osteomyelitis or deep abscess
• Grade 4 : Localized gangrene (Toes or fore foot)
• Grade 5 : Extensive gangrene (mid foot or hind
foot) requiring major amputation
13.
14. Neuropathic foot
• Sensory, autonomic and motor neuropathy contribute
to the pathogenesis of Neuropathic foot.
• Motor weakness leads to atrophy of the small
muscles of the foot with an imbalance between the
flexors and extensors. This results in clawing of the
toes and prominent metatarsal heads.
High foot pressure develops under the metatarsal
heads.
• Dry, brittle skin (as a result of autonomic neuropathy)
and high foot pressure lead to callus formation. The
callus can cause tissue damage and ulceration.
15. Diagnosis and assessment of
diabetic foot
Thorough neurological examination to detect
sensory, motor or autonomic nerve deficit.
H/o rest pain, intermittent claudication. Examination
of peripheral pulses, capillary filling.
Doppler study.
Estimation of blood glucose, Hb.TLC,DLC, urea,
creatinine
and lipids.
• X‐ray to detect osteomyelitis
16. Management of diabetic foot
• Infections are treated by wound debridement,
proper antibiotic, multiple insulin injections to
achieve good control of blood glucose.
• Exercise, cessation of smoking. Use drugs like
pentoxyphylline, aspirin, and thrombolytic agents to
improve blood supply.
• Angioplasty, bypass, stenting, atherectomy and laser
ablation of atherosclrotic plaque
17. • Attempt to convert wet gangrene to a dry one
by repeated dressings and proper antibiotics.
• Once gangrene sets in, decide for amputation.
18. Surgery in diabetic patients
• Diabetic patients are prone to develop sudden
hyperglycemia or hypoglycemia during surgery.
So, frequent monitoring of blood glucose is
necessary.
• Short acting insulin is given during surgery and
in the immediate postoperative period.
• They are admitted a few days ahead of surgery.
19. • Oral hypoglycemic drugs are stopped a few
days before major surgery and insulin is
started, to bring about better control of blood
sugar. Insulin is continued for a few days in the
postoperative period also.
• Wound healing is likely to be delayed
20. Q1-Dibetes mellitus is defined when in glucose
tolerence test ( 75 g glucose followed by blood
sugar measurement, after 2 hr) is
A. less than 140 mg/dl
B. between 140-200
C. >200 mg/dl
D.180 mg /dl
21. 2.Long term complication of DM is-
a.Heart disease
b. renal disease
c. diabetic foot
d. all above
22. 3.Most common cause for leg amputation-
a.venous ulcer
b.trauma
c.Buerger disease
d. diabetic foot
24. 5. A diabetic pt on oral hypoglycemic agent is planned
for surgery, which one is true-
a. oral hypoglycemic drug should not be stopped
b.oral hypoglycemic agent should be stopped few days
before surgery and long acting insulin should be
started pre and post op
c.oral hypoglycemic agent should be stopped few days
before surgery and short acting insulin should be
started pre and post op for few days
25. 6. In diabetic patient level of Glycated
haemoglobin (HB A1C) is more than
A. 8.0%
b. 6.5%
c. 4.5%
d. 9.2%