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Diabetes mellitus
Introduction
Classification diabetes mellitus
Disease progression
Diagnosis
Treatment
Complication
Dental management
Introduction
Pancrease
Islet of langerhans cell
Insulin
Glucose
Introduction
Introduction
Hyperglycemia
Introduction
Introduction
Definition of diabetes mellitus
A chronic systemic disease characterized
by disorder in(1) Metabolism of insulin and
of carbohydrate,fat,and protien(2) The
structure and function of blood vessels
From hyperglycemia
Introduction
Cause
Genetic
Destroy of Islet of langerhans cell
Endocrine
On steroid
Ab to insulin
Drugs and toxicity
2.NIDDM(Type II diabetes)
-Genetic
-Obesity
-Hemochromatosis
2.Endocrine disorder
-Cushings syndrome
-On steroid
3.Insulin resistance
1.IDDM(Type I diabetes)
2.NIDDM(Type II diabetes)
IDDM
NIDDM
NIDDM
65%
>40 year
Female>male
Obesity
Not severe
NIDDM
Normal or
increase insulin
Slow onset
Ketoacidosis rare
NIDDM
arteriosclerosis
Family history
rare
Disease progression
1.Prediabetes
Present abnormal glucose level
Disease progression
3.Chemical diabetes
asymptomatic
Normal (FBS)
Abnormal glucose tolerance after
meal 1-2 hr.
microangiopathy
Disease progression
4.Clinical diabetes
symptomatic
Increase (FBS)
Abnormal glucose tolerance
Diagnosis
1.
2. 45 (
1-3 )
3.(
1-3 )
Diagnosis
1.
Polydipsia
Polyuria
Polyphagia
Weight loss
Diagnosis
1.
Xerostomia
Candidiasis
Periodontitis
Caries
Abnormal tast
Diagnosis
2. 45 (
1-3 )
Diagnosis
3.(
1-3 )
Family
Obesity
Hypertention (140/90mmHg)
HDL-chlolesteral(35mg/dl)
Triglyceride(250mg/dl)
IGT
4 .
Diagnosis
Laboratory
FBS(fasting plasma glucose)
OGGT(oral glucose tolerance)
Urine
Ketone and eletrolytes
Renal functoin
Glycosylate hemoglobin
Diagnosis
Diagnosis
1.FBS 126mg/dl
2.Random plasma glucose 200mg/dl
3.plasma glucose after oral glucose
tolerance test (OGGT) 200mg/dl
Treatment
1.Food control
2.Drugs
3.Insulin
4.Excercise
Treatment
1.Food control
Treatment
2.Drugs
Sulfonylurea
Biguanide
Glycosidase inhibitor
Thiazolidinedion
Treatment
3.Insulin
IDDM
NIDDM
Primary failure
Secondary failure
Treatment
4.Excercise
Complication
Acute complication
1.Hypoglycemia
2.Diabetic ketoacidosis
3.Diabetic nonketotic hyperosmolar coma
4.Lactic acidosis
Complication
Chronic complication
1.Microvascular
Nephropathy
Retinopathy
Neuropathy
Complication
Chronic complication
2.Macrovascular
Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease
Retinopathy
Dental management
Poor moduality
Well moduality
consultation
Dental management
Well moduality
Infection
Hypoglycemia
Insulin reaction
Dental Management
Minor surgery , Local anesthesia
Well moduallity
Insulin
Drug
NPH 1/3-1/2
before surgery
Stop before
surgery
Surgery
Insulin / Drug
Poor moduality
Consultation
Dental Management
Major surgery , General anesthesia
Well moduallity
Insulin
Poor moduality
Drug
- EKG,Electrolytes
- D5W IV
Surgery
Monitor blood sugar level
Insulin every 6 hrs
Drug
Consultation