Diabetes mellitus
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Transcript Diabetes mellitus
DIABETES MELLITUS
TYPE I & II
Amall Saleh
Aaisha Alahwas
Lili Wu
What is Diabetes?
• A group of metabolic diseases in which the person has high blood
glucose
• Insulin production is inadequate
• Or body cells do not respond properly to insulin
Symptoms
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INCREASED THIRST
FREQUENT URINATION
INCREASED HUNGER
WEIGHT LOSS
FATIGUE
BLURRED VISION
SLOW-HEALING SORES
FREQUENT INFECTIONS
Diagnosis
• Fasting blood glucose test
• Random(non-fasting) blood glucose test
• Oral glucose tolerance test
• Hemoglobin A1c test
Type I Diabetetes Mellitus
Autoimmune destruction of pancreatic beta cells
Little or no production of insulin
Most often diagnosed in children, adolescents and young adults
Insulin-dependent
Unknown cause; genetic
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/#adam_000305.disease.treatment
Insulin
• Only effective medication for
Type I diabetes
• Administered subcutaneously via
insulin pen, syringe or pump
Types
of
insulin
• Short/rapid acting insulins(1520 min)
• Intermediate acting insulins
• Long acting insulins
Mechanism of Action
• Acts via specific membrane-bound receptors on target tissue
• Regulates metabolism of carbohydrate, protein, and fats
CASE STUDY
Living with Type I Diabetes
PATIENT PROFILE
Female;29 years old;Asian
Controlled Type I Diabetes
Diagnosed in 1998 (13 yrs old)
Symptoms lead to diagnosis :
• Excessive hunger/thirst
• Craving for sweets
• Sudden weight loss
The critical event that triggered diagnosis of Type I diabetes:
• Patient passed out at school and got sent to a hospital
Treatment History
Upon initial diagnosis, oral medication for one month
Soon switched to insulin injection twice/day
During puberty, attempted different types of insulin for optimal
result
Age 15-20, insulin injection with syringe: Insulin aspart(NovoLog)
twice/day
Age 20-28, insulin injection with pen: Insulin aspart(NovoLog
FlexPen) 2-4 time/day
GLYCEMIC EPISODES before insulin pump…
Hyperglycemia
Feeling tired and sleepy
Symptoms not obvious
Hypoglycemia
Weakness
Dizziness
Sweating
Shaking of hands
Mental confusion
CURRENT TREATMENT
Patient is trying to become pregnant
Carries an insulin pump since Feb 2013
INSULIN PUMP
Two functions:
Basal rate---5 time settings
Bolus rate
Suggested glucometer
monitoring:
7 times/day
Life with Type I Diabetes
Endocrinologist visit once/month
A1C test every 3 months
Podiatrist, optometrist visit once/year
In 2012, patient decided to quit her job. Job required frequent
travels. Physically and emotionally draining. Her energy level could
not keep up with job requirements.
DENTAL HYGIENE MANAGEMENT
Coral tissue with generalized
moderate marginal inflammation
Type II—Probing depths 3-6mm,
localized 4-6mm in posteriors
Moderate BUP
DENTAL HYGIENE MANAGEMENT
One week after SRP of LR posteriors
Patient complained about pain and
swelling that occurred 2 days after
SRP
Slightly erythematous and necrotic
attached gingiva and papillary tissue
Delayed tissue healing
Type II Diabetes Mellitus
It’s a non-insulin-dependent diabetes mellitus (NIDDM) or
adult-onset diabetes
Usually occurs in older, obese adults.
Type II does not have an autoimmune cause, usually its
genetics.
Insulin level can be normal, high, or low in patients with type II
diabetes
It has the same symptoms as type I.
OVERALL M.O.A. OF DRUGS
o There are many categories of type II diabetes medications that
exist.
o Each work differently to lower blood sugar.
Stimulate the pancreas to make and release more insulin
Stops the production and release of glucose
Blocks the action of stomach enzymes that break down carbohydrates
Improves tissue sensitivity to insulin
Stops the reabsorption of glucose in kidneys
Glipizide (Glucotrol)
• Pharmacologic Category- Sulfonylurea
• MOA- Stimulates the release of insulin, and reduces the glucose
output from the liver.
• Adverse Effects
• Syncope (fainting)
• Hypoglycemia (low level of glucose in the blood)
• Weight gain
• Skin Rash
• Nausea.
Drug Interaction
Levels of Glipizide may be increased by:
Beta Blockers
Cimetidine
Cyclic Anti-depressants
MAO Inhibitors
Selective Serotonin Re-uptake Inhibitors.
Corticosteroids (orally inhaled) and (systemic)
Levels of Glipizide may be decreased by
Loop Diuretics
Thiazide Diuretics.
Dietary Consideration-
If tablet is taken with food a delayed
release of insulin occurs. Therefore, take the tablets 30 minutes before
meals.
Metformin (Fortamet)
• Pharmacologic Category- Biguandes
• MOA- Inhibits the release of glucose from the liver. Decreases
intestinal absorption of glucose and improves insulin sensitivity.
• Adverse Effects• Nausea
• Diarrheas
• Rash
• Hypoglycemia
Drug Interaction
Levels of Metformin may be increased by:
Carbonic Anhydrase Inhibitors
Cephalexin
Cimetidine
Dalfampridine
Ranolazine.
Levels of Metformin may be decreased by :
Corticosteroids (orally inhaled) and (systemic)
Somatropin
Thiazide Diuretcs
Dietary Consideration- Metformin may cause GI upset, so to decrease
GI upset administer with a meal.
Rosiglitazone (Avandia)
• Pharmacologic Category- Thiazolidinedione
• MOA- Lowers blood glucose by improving target cells response
to insulin, and it is dependent on insulin for activity.
• Adverse Effects• Weight gain
• Anemia
• Edema
• Hypoglycemia
Drug Interaction
• Levels of Rosiglitazone can be increased by:
• MAO Inhibitors
• Selective Serotonin Reuptake Inhibitors
• Vasodilators
• Levels of Rosiglitazone can decreased by :
Corticosteroids (orally inhaled) and (systemic)
Thiazide Diuretcs
Loop Diuretics
Saxagliptin (Onglyza)
• Pharmacologic Category- dipeptidyl peptidase inhibitor-4
(DPP-4)
• MOA- Reduces blood glucose. Regulates the incretion hormones
such as glucagon-like peptide-1 (GLP-1) and glucose-dependent
insulin tropic polypeptide (GIP).
• Adverse Effects• Upper respiratory tract infection
• Peripheral edema
• Hypoglycemia
Drug Interaction
• Levels of Saxagliptin can be increased by :
• MAO inhibitors
• ACE inhibtors
• Selective Serotonin Reuptake Inhibitors
• Levels of Saxagliptin can be decreased by:
Corticosteroids (orally inhaled) and (systemic)
Thiazide Diuretcs
Loop Diuretics
Acarbose (precose)
• Pharmacologic Category: Alpha-glucosidose inhibitors
• MOA- Inhibits the metabolism of sucrose to glucose and
fructose.
• Adverse Effects• Flatulence (Gas)
• Diarrhea
• Abdominal pain
• No major drug interaction
• These medications are used as an adjunct to exercise and diet
to improve glycemic control in adults with type 2 diabetes.
Role of the Dental Hygiene Team
• Providing definitive screening of patients.
• Be familiar with ADA standards of medical care.
• Use The Diabetes Risk Test questions to educate and motivate.
• Refer patients for medical follow-up when indicated.
QUESTIONS FOR THE CLASS
Q1. Name one drug that interacts with
Metformin.
Answer
Carbonic Anhydrase Inhibitors
Cephalexin
Cimetidine
Dalfampridine
Ranolazine.
Corticosteroids (orally inhaled) and (systemic)
Somatropin
Thiazide Diuretcs
Q2
• List symptoms of diabetes mellitus.
Answer
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Increased thirst
Frequent urination
Increased hunger
Weight loss
Fatigue
Blurred Vision
Slow-healing sores
Frequent infections
Q3
•Which type of diabetes is insulindependent? Which type is non-insulin
dependent?
Answer
•Type I-insulin dependent
•Type II- non-insulin dependent
Q4
•Which drug is used to treat Type IDM?
Answer
• Insulin
REFERENCES
•
American Diabetes Association. Standards of medical care in diabetes 2014. Diabetes
Care.2014;vol. 37:no. Supplement 1:S14-S80.
•
Wilkins, Esther M. Clinical Practice of Dental Hygienist. Philadelphia. Lippincott William &
Wilkin, 2013. Print.
•
Wynn, R. L., Meiller, T. F., Crossley, H. L. (2014). Drug information handbook for dentistry.
(20th ed.) St. Louis, MO: Wolters Kluwer Health Inc.
•
http://www.diabetes.org/living-with-diabetes/treatment-and
care/medication/insulin/insulin-basics.html
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http://www.medicalnewstoday.com/info/diabetes/
•
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/#adam_000305.disease.treatme
nt