2.  It is a persistent increase of blood glucose level,it is a result of absolute or relative deficiency of insulin.

3.  There are two types of DM:  1\Type 1 :insulin-dependent  Young onset (childhood & adolescence).  Pt with normal weight.  Decrease blood insulin.

4.  2\Type 2 :  Non-insulin dependent.  Adult onset diabetes.  Risk factors :age, obesity, alcohol, diet, family history and lack of physical activity.  Normal or increase blood insulin.

5.  Excessive of urination occurs ( polyuria).  Increase fluid loss lead to dehydration and excess thirst.  Increase hunger feeling.  Loss of wight.

6.  Gingivitis.  Alveolar bone resorption.  Xerostomia.  Delayed wound healing.  Pulpitis in non caries tooth.  Burning sensation in tongue.  Acetone smell in breath.  Increase of infection (Candida).  Ulcers.

7.  A plasma glucose level of 200mg\dl or more with symptoms presented.  Fasting plasma glucose level 126-or more.and normal (<110mg\dl).

8.  Exercise and diet control.  Insulin : rapid, short, intermediate, long acting.  Oral antidiabetic agent.

9.  Morning appointment and short.  Ensure that the patient has eaten and taken medication.  Blood glucose controlling (measured before beginning ).  Prophylactic antibiotics (established infection,major surgery, pre operation contamination wound).

10.  During treatment there complication of DM are :  hypoglycemia( most complication).  Hyperglycemia.

11.  Signs:  Headache.  Confusion.  Hunger.  Weakness.  Sweating.  Tachycardia, cool and pale.  Consequence in unconsciousness, hypotension, seizures', coma even death.

12.  Management:  Maintain airway.  Keep pt supine.  15 grams of fast-acting oral carbohydrate.  Measured blood sugar.  Loss of conscious 25-30ml 50%dextrose solution I.V over 3min period.  Glucagon 1mg.  Assess vital signs.  Call ambu lance.

13.  Signs : nausea.  Vomiting.  Abdominal pain.  Acetone odor.  Management:  Need medication intervention and insulin.

16.  Symptoms:  Decrease urine out put 70%  Edema.  Mental changes.  Heart failure.  Nausea, vomiting.  Anemia.  Cool, pale, moist skin..

17.  Taste and smell ammonia.  Stomatitis (ulcer).  Gingivitis.  Decrease salivary flow ( high caries rate).  Parotitis.

18.  Dialysis:  It diffuse harmful waste out of body.  3-4 times a week and take 2-4 hours.  (machine filters blood and return it to body ).

19.  Determine dialysis schedule & treat on the day after dialysis.  Consult with the patient physician for antibiotics prophylaxis.  Avoid taking blood pressure measurement,injection of medication on the arm with (shunt).  Allow pt to walk or stand during procedures.  Take hepatitis precaution if un able to screen for hepatitis.

20.  Note:  The bleeding is the most commonly affect patient after periodontal or surgery treatment  We can use anti fibrinolytic agent in the form of mouth wash or soaked gauze on bleeding site.

21.  That include:  Liver cirrhosis.  Jaundice.

22. 1) reduced drug detoxication e.g. sedative, analgesic, general anesthesia. 2) Bleeding disorders due to decrease clotting factors, excess fibrinolysis,decrease vitamin K absorption. 3) Transmission of viral hepatitis.  Recommendation to dental practitioners:  HBV vaccination for all staff.  Protocols: hand wash before Tx.  Routine use of gloves and protective eyes wear.  Using masks & gowns.  Heat sterilizing hand pieces between pt.  Disposable instrument or individual instrument for each patient.

23.  Medical consultation.  Avoid drugs metabolized in liver:  L.A (lidocaine )& G.A (caused bleeding).  Sedatives (valium).  Antibiotics (ampicillin).  Analgesics (aspirin).  recommended to give pt VIT K (10 mg/day before surgery).

24.  Thyroid function : produce T3 and T4 which regulate the body metabolic rate and increase protein synthesis.  Types of thyroid disease :  1\hyper thyrodism.  2\hypo thyrodism.

25.  Symptoms :  Nervousness.  Anxiety.  Heat intolerance.  Fatigue.  Weight loss.  Palpitations.  Rapid heart beat.  Worm moist skin.  Diarrhea.  aOpthlmopathy : edema & inflammation of the extra ocular muscles.

27.  Beta blockers (propranalol).  Subtotal \radioactive iodine.  Dental management :  Recognize signs & symptoms.  Patient un treated or incompletely treated are very sensitive to epinephrine (adrenaline) do not administer.

28.  Symptoms:  Increase sensitivity to cold.  Constipation.  over weight.  Weakness.  Dry hair & skin.  Puffy eyelids.  Moving & thinking slowly.

30.  T4 ( thyroxin).  Dental treatment :  Recognize signs & symptoms.