Diabetes mellitus

1. By kraisorn inphiban

2. Diabetes mellitus
• Introduction
• Classification diabetes mellitus
• Disease progression
• Diagnosis
• Treatment
• Complication
• Dental management

3. Introduction
•Pancrease
•Islet of langerhans cell
•Insulin
•Glucose

4. Introduction

5. Introduction
• Hyperglycemia
• Normal 65-110 mg/dl
• Abnormal 126 mg/dl

6. Introduction

7. Introduction
• Definition of diabetes mellitus
– A chronic systemic disease characterized
by disorder in(1) Metabolism of insulin and
of carbohydrate,fat,and protien(2) The
structure and function of blood vessels
– From “hyperglycemia”

8. Introduction
• Cause
–Genetic
–Destroy of Islet of langerhans cell
–Endocrine
–On steroid
–Ab to insulin
–Drugs and toxicity

9. Classification diabetes mellitus
• Primary diabetes mellitus
1.IDDM(Type I diabetes)
-Genetic
-Autoimmune
2.NIDDM(Type II diabetes)
-Genetic
-Obesity

10. Classification diabetes mellitus
• Secondary diabetes mellitus
1.Injury of pancrease
-Infection of pancrease
-Hemochromatosis
2.Endocrine disorder
-Cushing’s syndrome
-On steroid

11. Classification diabetes mellitus
• Secondary diabetes mellitus
Acromegaly
Pheochromocytoma
Glucagonoma
Somatostatinoma
3.Insulin resistance

12. Classification diabetes mellitus
1.IDDM(Type I diabetes)
2.NIDDM(Type II diabetes)

13. Classification diabetes mellitus
•IDDM

14. •NIDDM
Classification diabetes mellitus

15. Classification diabetes mellitus
• IDDM
–35%
–<25 year
–Female=male
–Normal weight
–Severe
• NIDDM
–65%
–>40 year
–Female>male
–Obesity
–Not severe

16. Classification diabetes mellitus
• IDDM
– Decrease insulin
– Rapid onset
– Ketoacidosis
common
• NIDDM
– Normal or
increase insulin
– Slow onset
– Ketoacidosis rare

17. Classification diabetes mellitus
• IDDM
–Microangiopathy
–Family history
commom
• NIDDM
–arteriosclerosis
–Family history
rare

18. Disease progression
• 1.Prediabetes
–Present abnormal glucose level
• 2.Latent chemical diabetes
–asymptomatic
–Normal (FBS)
–Normal Glucose tolerance
–microangiopathy

19. Disease progression
• 3.Chemical diabetes
–asymptomatic
–Normal (FBS)
–Abnormal glucose tolerance after
meal 1-2 hr.
–microangiopathy

20. Disease progression
• 4.Clinical diabetes
–symptomatic
–Increase (FBS)
–Abnormal glucose tolerance

21. Diagnosis
1.ผู้มีอาการของโรคเบาหวาน
2.ผู้มีอายุ 45 ปี ขึ้นไป(ถ้าผลปกติให้
ตรวจทุก1-3ปี )
3.ผู้ไม่มีอาการแต่มีปัจจัยเสี่ยง(ถ้าผล
ปกติให้ตรวจทุก1-3ปี )

22. Diagnosis
1.ผู้มีอาการของ
โรคเบาหวาน
•Polydipsia
•Polyuria
•Polyphagia
•Weight loss

23. Diagnosis
1.ผู้มีอาการของ
โรคเบาหวาน
• Xerostomia
• Candidiasis
• Periodontitis
• Caries
• Abnormal tast

24. Diagnosis
2.ผู้มีอายุ 45 ปี ขึ้นไป(ถ้าผลปกติ
ให้ตรวจทุก1-3ปี )

25. Diagnosis
3.ผู้ไม่มีอาการแต่มีปัจจัยเสี่ยง(ถ้าผล
ปกติให้ตรวจทุก1-3ปี )
Family
Obesity
Hypertention (≥140/90mmHg)
HDL-chlolesteral(≥35mg/dl)
Triglyceride(≥250mg/dl)
ประวัติ IGT
ประวัติคลอดลูกน้าหนักเกิน 4 กก.

26. Diagnosis
•Laboratory
–FBS(fasting plasma glucose)
–OGGT(oral glucose tolerance)
–Urine
–Ketone and eletrolytes
–Renal functoin
–Glycosylate hemoglobin

27. Diagnosis
• Diagnosis
1.FBS ≥ 126mg/dl
2.Random plasma glucose ≥ 200mg/dl
3.plasma glucose after oral glucose
tolerance test (OGGT) ≥ 200mg/dl

28. Treatment
1.Food control
2.Drugs
3.Insulin
4.Excercise

29. Treatment
1.Food control

30. Treatment
2.Drugs
–Sulfonylurea
–Biguanide
–Glycosidase inhibitor
–Thiazolidinedion

31. Treatment
3.Insulin
– IDDM
– NIDDM
• Primary failure ไม่ตอบสนองต่อยาตั้งแต่
เริ่มต้น
• Secondary failure เกิดภาวะดื้อยาใน
ภายหลัง

32. Treatment
4.Excercise

33. Complication
•Acute complication
1.Hypoglycemia
2.Diabetic ketoacidosis
3.Diabetic nonketotic hyperosmolar coma
4.Lactic acidosis

34. Complication
Chronic complication
1.Microvascular
• Nephropathy
• Retinopathy
• Neuropathy

35. Complication
Chronic complication
2.Macrovascular
• Coronary artery disease
• Cerebrovascular disease
• Peripheral vascular disease

36. Retinopathy

37. Dental management
Poor moduality consultation
Well moduality

38. Dental management
• Well moduality
–ควรนัดตอนเช้า
–ให้ผู้ป่ วยรีบบอกก่อนมี
อาการผิดปกติใดๆ
–Infection
–Hypoglycemia
–Insulin reaction

39. Dental Management
Minor surgery , Local anesthesia
Well moduallity Poor moduality
Insulin Drug
NPH 1/3-1/2
before surgery
Stop before
surgery
Surgery
Insulin / Drug
Consultation

40. Dental Management
Major surgery , General anesthesia
Well moduallity Poor moduality
Insulin Drug
- EKG,Electrolytes
- D5W IV
- No drug before surgery
- D5W IV
Surgery
Insulin every 6 hrs
Consultation
Drug
Monitor blood sugar level