diabetes malitus

1. Detailed management of diabetes patient
-surabhi desai

2. INTRODUCTION
• Diabetes is the common endocrine disorder.it
is a disease marked by high level of blood
glucose which results from defect in insuline
production or insulin action or both.approx
135 million people worldwide have diabetes.

3. • Type1:insulin dependent diabetes mellitus
• Type:non-insulin dependent diabetes mellitus
• Recently it is also classificed as:
• Adult-onset
• Juvenile-onset
• GESTATIONAL DIABETES MELLITUS

4. AMMERICAN DIABETIC ASSOCIATION
• TYPE1:IMMUNE MEDIATED
• IDIOPATHIC
• TYPE2:GENETIC PANCREATIC BETA CELL
DEFECT,GENETIC DEFECT IN INSULIN
RECEPTOR,PANCREATIC
DISEASE:TRAUMA,INFECTION,INFLAMMATION
,NEOPLASM
• ENDOCRINOPATHIES: growth
hormone,cortisol,glucagon,epinephrine

5. Ammerican diabetic association
• Drug or chemical induced
• Nicotinic acid,glucocorticoid,thyroid,phenyoid
thiazides
• INFECTION
• VIRAL,RUBELLA,CYTOMEGALOVIRUS,MUMPS,ADE
NOVIRUS
• OTHER GENETIC
SYNDROME;DOWN,KLINEFELTER,TURNER
• Impared glucose tolerance,impaired fasting
glucose

6. Impaired fasting glucose….normal fasting
glucose is taken as less than or equal to
110mg/dl,fasting plasma glucose level btw 110-
126 is considered having impaired fasting
glucose….
Impaired glucose tolerance….postprandial
glucose between 140-200mg/dl

7. HYPERGLYCEMIA
• etiology
• WEIGHT GAIN
• CESSATION OF EXERCISE
• PREGNANCY
• HYPERTHYROIDISM
• EPINEPHRINE THERAPY
• CORTICOSTEROID THERAPY
• ACUTE INFECTION
• FEVER
• Skin is warm

9. HYPOGLYCEMIA
• etiology:
• WEIGHT LOSS
• INCREASED PHYSICAL EXERCISE
• TERMINATION OF PREGNANCY
• TERMINATION OF DRUGS
• RECOVERY FROM INFECTION AND FEVER
• Skin is cold

11. • Genetic factor
• Environment factor..epidemic of
mumps,congenital rubella associated with
type1
• Autoimmune factor:for type1
• Type2
• Three cardinal abnormalities…resistance of
action of insulin in peripheral
tissue.particularly muscle,fat,liver

12. • 2..defective insulin secretion particularly in
response to glucose stimulus.
• 3.increased glucose production by liver
• Obesity
• Insuline resistance
• Insulin secretion

13. What to ask??????

14. Medical history……..
• Recent weight loss???
• Fever night sweat???
• Recurrent infection???
• Excessive thrist ,urination,hunger???do you get
up at night to void urine???
• Family history of diabetes???
• Any medication taken???
• Dry mouth???
• Delayed wound healing???

15. • How often do you monitor your urine or blood
glucose level?what is your glycosylated hb test
result???
• How frequently(IF EVER) do you experince
hypoglycemic episodes???
• Ask for neuropathy
,nephropathy,retinopathy???

16. Hyperglycemia
• Diagnostic clues:
• Acidosis with blood ph..7.3
• Dry warm skin
• Kussmauls respiration
• Fruity sweet breath odor
• Rapid weak pulse
• Altered level of consciousness

17. • Hyperglycemia Conscious patient-should not
receive any dental treatment untill physician is
consulted
• Unconscious patient-
• Step1:termination of dental therapy
• Step2:activation of dental office emergency
team
• Step3:patient kept in supine position with legs
elevated

19. • Step3:removal of dental material from mouth
• step4:A-B-C….air breathing circulation
• Check airway…breathing pulse…must initate basic
life support.adequate oxygenation is given,untill
underlying matabolic cause is removed patient
remains unconscious
• Step5:iv infusion of dextrose and normal
saline..insulin must be administered carefully and
blood test performed to monitor effect
• step6:adminstration of oxygen

21. • transportation of patient to hospital
• A B C D P
• hypoglycemia-conscious patient
• Step1:recognition of hypoglycemia…dr should know how long ago
he ate or took insulin
• Step2:termination of treatment
• E soft can
• Step4:administration of oral carbohydrates..sugar orange juice
candy
• step5:RECOVERY

22. Drugs and insulin

23. treatment
• Various treatment option:
• Diet plus life style modification
• Diet plus oha
• Diet plus insulin
• Diet plus oha plus insulin
• The recommended allocation of calories are
• Carbohydrates(50%)protein(10-15%)fats(30-
35%)

24. • DRUGS FOR TYPE2:
• Biguanides….ex:METFORMIN..increased insulin
sensitivity
• THIAZOLIDINEDIONES…..ex:rosiglitazone,pioglitazone
.stimulate insuline secretion..inc insulin sensitivity,lower
ldl,inc glucose uptake by tissues
• sulfonylurea:GLIPIZIDE,GLUBURIDE,TOLBUTAMIDE..stim
ulate insulin secretion
• meglitinides:repaglinide….stimulate insulin secretion
• Glucosidase inhibitors:acarbose….decreases hydrolysis
and absorption of complex carbohydrate

25. INSULIN PREPARATION
• Rapid acting…lipro,aspart
• Regular cting…humulinR novolinR
• Intermediate-acting:nph
• Long-acting-insulin glargine

26. • Vascular
system:artherosclerosis,microangiopathy
• kidnay: diabetic gluromeurlonephritis
• Nervous system:neuropathy
• Eyes:retinopathy,glaucoma
• skin..diabetic xanthoma,mycosis,pruritus
• Pregnancy..large babies,still births,congenital
defects
• Diabetic foot ulcer
• Diabetic ketoacidosis,hypoglycemic coma