6. Diabetes affects more than 20 million Americans. Over 40 million Americans have prediabetes

9. NormalType 1 DM Type 2 DM

10. Type 1Type 2 Incidence Less common More common Occurrence ChildhoodAdulthood Mechanism The body makes little or no insulin ( cause is unknown. Genetics, viruses, and autoimmune problems may play a role ) The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin Treatment Daily injections of insulin are needed Oral hypoglycemic drug

11. Type 1Type 2 Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting. Type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all. Fatigue Increased thirst Increased urination

12. Type 1Type 2 Nausea Blurred vision Vomiting Weight loss in spite of increased appetite Increased appetite

13. Gestational diabetes: is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Alternative Names Glucose intolerance during pregnancy Causes, incidence, and risk factors -African or Hispanic ancestry -Being older than 25 when pregnant -Family history of diabetes -Giving birth to a previous baby that weighed more than 9 pounds -Obesity -Recurrent infections

14. Symptoms Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. Often, the blood glucose level returns to normal after delivery. Symptoms may include: 1-Blurred vision 2-Fatigue 3-Increased thirst 4-Frequent infections, including those of the bladder, vagina, and skin 5-Increased urination 6-Nausea and vomiting However, high blood sugar levels in the mother can cause problems in the baby. These problems can include: 1-Birth injury (trauma) because of the baby's large size 2-Increased chance of diabetes and obesity

15. Tests: A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood glucose tests are used to diagnose diabetes: 1-Fasting blood glucose level: diabetes is diagnosed if>126 mg/dL 2-Oral glucose tolerance test: diabetes is diagnosed if> 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.) 3-Random (non-fasting) blood glucose level: diabetes is suspected if>than 200 mg/dL and accompanied by the classic diabetes symptoms 4-Hemoglobin A1c (HbA1c) level: checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to follow up the patient.

16. COMPLICATIONS: 1-Atherclerosis 2-Nephropathy 3-Retinopathy

18. -Xerostomia, increased caries -Dry atrophic cracked oral mucosa, angular chellitis -Mucositis, ulcers, and desquamative gingivitis, burning mouth syndrome -Difficulty swallowing -Opportunistic bacteria, fungal, viral infection

19. -Poor Wound Healing -Periodontal Disease-usually in poorly controlled or undiagnosed diabetics -Incidence of Periodontal Disease increases among patients with diabetes as they age -Diabetics with advanced systemic conditions have periodontal disease more frequently and severe.

20. -It is important to get a complete health history, before starting any treatment. -Ask the undiagnosed diabetic about signs and symptoms, family history, and determine if they are at risk. -Ask the known diabetic about their glucose levels, how they control their glucose, their last doctor’s visit, and if they are displaying any symptoms of diabetes now. -Any elective dental treatment should be postponed until the glucose level is under control (70mg/dl 200mg/dl)

21. -Short morning appointments -Instruct patient to eat normal AM meal -Frequent hygiene recalls -Antibiotic management for acute infections -Stress reduction protocol (Endogenous production of epinephrine and cortisol increase during stressful situations. These hormones elevate blood glucose levels and interfere with glycemic control. Adequate pain control and stress reduction are therefore important in treating diabetic patients. Profound anesthesia reduces pain and minimizes endogenous epinephrine release. The small amounts of epinephrine in dental local anesthetics at 1/100,000 concentration have no significant effect on blood glucose.)

22. Hypoglycemia presents with: 1-Nervousness 2-Sweating 3-Tremor 4-Headache 5-Confusion Treatment of the conscious patient includes giving oral carbohydrates, and continue assessing vital signs Unresponsive patient-activate ABC’s, and administer parenteral carbohydrates.

23. Hyperglycemia presents with: 1-Blood glucose levels greater than 250 mg/dl 2-Dry, warm skin 3-Hyperventilation 4-Fruity, sweet breath 5-Rapid weak pulse, and normal to low BP Conscious patient-supportive care Unconscious patient- ABC’s, Do not administer insulin Start IV of 5% Dextrose and normal saline before EMT arrive

25. The number of diabetic patient in dental clinic become a great number & need special precautions in it is treatment. Diabetes is microvascular & macrovascular disease with a harmful effect on the body organs. If, patient develop coma in dental clinic, give him glucose whatever, it’s hyper or hypoglycemic coma As, brain is sensitive to glucose.