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Diabetes affects
more than 20
million Americans.
Over 40 million
Americans have
prediabetes
Diabetes Mellitus
Diabetes Mellitus
Causes , incidence , and risk factors
Insulin is a hormone produced by the pancreas
to control blood sugar. Diabetes can be
caused by too little insulin, resistance to
insulin, or both.
Digestion
Sugar in food Absorption
Glucose Blood stream
Glucose remain
in blood
( High glucose
level )
The cell Glucose can ’ tEnter the cell
resist enter the cell
entrance of due to lack of
the glucose insulin
to it ,
in spite of
Type 2 DMof
presence Type 1 DM Normal
Diabetes Mellitus
Type 1 Type 2
Incidence Less common More common
Occurrenc Childhood Adulthood
e
Mechanis The body makes The pancreas does
m little or no not make enough
Treatment Daily injections Oral hypoglycemic
insulin to keep
insulin
of insulin are drug
blood glucose levels
(needed
cause is unknown.
normal, often because
Genetics, viruses, and
autoimmune problems may the body does not
)
play a role respond well to
insulin
Diabetes Mellitus
Type 1 Type 2
Patients with type 1 Type 2 diabetes develops
diabetes usually slowly, some people with
develop symptoms over high blood sugar
a short period of experience no symptoms
time. The condition at all.
is often diagnosed in
an emergency setting.
Fatigue Fatigue
COMPLICATIONS :
1-Atherclerosis
2-Nephropathy
3-Retinopathy
Diabetes Mellitus
Diabetes Mellitus
-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
Diabetes Mellitus
-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.
Dental Management
-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
Dental Management
-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.)
Managing the Hypoglycemic
Emergency
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.
Managing the Hyperglycemic
Diabetic
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
Instruction to diabetic
patient
Conclusion