2. diabetes Prior classification of diabetes 1.Diabetes mellitus a. type1-insullin-dependent diabetes mellitus b. type2-noninsullin- dependent diabetes mellitus c.type3-other types of diabetes 2.impaired glucose tolerance :IGT 3.gestational diabetes mellitus :GDM Previous abnormality of glucose tolerance :pre-AGT Potential abnormalities of glucose tolerance :post-AGT

3. Incidence and prevalence 200,000,000 all over the world 90-95% type 2 Third reason of death in USA

4. Etiology Type 1:HLAD, rubella,CMV, coxacy hepatitis, mumps Type 2: genetics,obesity

5. Pathophysiology and complications Diabetic eye disease diabetic retinopathy Cataract Glaucoma Diabetic neuropathy Diabetic nephropathy Stroke or cerebrovascular disease Coronary heart disease Acute myocardial infarction Cradiovascular disease Peripheral vascular disease Gastrointestinal disturbance

6. Laboratory test Fast blood sugar :FBS 2-post-prandial blood glucose OGTT Glycohemoglobin measurement Glucose of the urine

7. Acute Diabetic complication Hypoglicemia Diabetic ketoasidosis :DKA Hyperosmolar hyperglycemia nonketotic syndrome

8. Sing and symptom of insulin reaction Mild stage :hunger, weakness, pallor, sweating, paresthesias,tachycardia Moderate stage :incoherence,uncooperativeness,belligerence, lack of judgment, poor orientation Severe stage :unconsciousness, tonic or clonic movements,hypotension, hypothermia, rapid thready pluse

9. Dental complications Periodontal disease Xerostomia Infection Caries

10. Dental management of diabetic patients Health questionnaire Assessing glycemic control Seeking a medical consultation Dental treatment consideration

11. Basic Patient Management Strategies Schedule dental appointments in the early to mid-morning hours Keep appointments short Use adjunct sedation procedures when appropriate Instruct patient to continue normal dietary intake before dental procedures Prior to an invasive procedure, check the patient’s blood glucose Modify diet to soft solids and liquids when patient is expected to have difficulty eating solid foods after dental procedures Perform appropriate follow-up care in the post-operative period Frequent recall examinations and prophylaxis Use of topical fluoride when patients are at risk for caries Supportive, palliative care for dry mouth using salivary substit

12. Conditions Which Warrant a Medical Consult When it is apparent that the patient has diabetic complications previously undiagnosed by their physician When the patient has not seen their physician within the past six months When the patient presents with an acute dental infection and the patient’s glucose exceeds 200 mg/dl If the patient has never had formal diabetes education training When questions arise about glycemic control and invasive dental procedures When adjustments of diabetes medications are needed Nutritional support during extended post-operative periods