©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

©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 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. 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 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. Functions of Glucose and Insulin 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 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. Functions of Glucose and Insulin 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 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. 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 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. Type I and Type II Diabetes 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 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. Type I and Type II Diabetes Complications of diabetes can include: –Macrovascular disease –Microvascular disease –Neuropathy Imbalance of glucose can result in the following conditions: –Hypoglycemia –Hyperglycemia 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. 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 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. Causes of Diabetes –Type II diabetes can be caused by pregnancy, which results in drastic hormonal changes in the body 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. 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 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. Classification –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 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. Classification –Accounts for majority of cases of diabetes –Usually controlled with diet, exercise, and oral hypoglycemics 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. 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 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. Gestational Diabetes 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 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. 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 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. Diabetic Emergencies: Hyperglycemia and Hypoglycemia Hyperglycemia: too much blood glucose Hypoglycemia: too little blood glucose Both of these can develop into an emergency situation 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. 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 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. Hyperglycemia –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 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. Hyperglycemia 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 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. Hyperglycemia 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 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. 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 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. Hypoglycemia 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 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. Hypoglycemia 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 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. 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 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. Diabetic Coma or Insulin Shock? –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 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. 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) 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. Medical Problems Diabetes increases microvascular (small- vessel) abnormalities via inadequate blood supply to the: –Eyes Diabetic retinopathy can cause blindness 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. 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 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. Oral Manifestations 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. Oral Manifestations Other oral diseases associated with diabetes include: Xerostomia Abnormal taste Prolonged or recurrent fungal or bacterial infections Burning mouth syndrome - painful, frustrating condition often described as a scalding sensation in the tongue, lips, palate, or throughout the mouth. Dental caries 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. Oral Manifestations –Consult the patient’s physician for any extensive treatment –Keep the patient calm during procedures –Avoid scheduling appointments during typical mealtimes 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 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 33

©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 –Adolescents may not be monitoring their blood sugar and controlling their diabetes Could experience a reaction during dental treatment 34

©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 35