Case Study 21

Javier is a 45-year-old surgical technologist who has been referred to the dental hygiene clinic for "deep cleaning" by his general dentist. He has type 2 diabetes mellitus, but due to his poor glycemic control, recently he has had to add insulin to his drug regimen. His medications include neutral protamine Hagedorn insulin , repaglinide (Prandin), colesevelam (WelChol), simvastatin (Zocor), lisinopril (Prinivil), and a baby aspirin. His blood pressure is 150/94, heart rate is 98, and his respirations are 15 breaths per minute. When you ask him how well his diabetes is controlled, he looks embarrassed and mumbles, "Okay, I guess." When you ask about his A1C, he says it was 8 the last time he visited the doctor. You do a finger stick test, and his results are 250. You asked him when his last visit was to the doctor, and he states that he hasn't been in several months due to a heavy work schedule of surgeries. You ask him if he has eaten because it is late in the day, and you know that he just came from the hospital. He says he has eaten and has taken his medications. As you examine his oral cavity, you note that his gingiva is fiery red and erythematous, and he has several areas that appear to be periodontal abscesses. His probe readings range from 4 to 8 mm, and there is spontaneous, excessive bleeding upon probing. The lower anterior mandibular teeth have grade 2 mobility.

Answer the questions regarding the case study.......

1. Which class of oral antihyperglycemic drugs is repaglinide (Prandin)?

a. Insulin

b. Sulfonylurea

c. Meglitinides

d. Thiazolidinedione

e. Dipeptidyl-peptidase-4-Inhibitor

f. α-Glucosidase inhibitor

c. Meglitinides

2. Which is the major advantage of repaglinide (Prandin) over other oral antihyperglycemic drugs?

a. Does not have to be taken with meals

b. Positive effect on cholesterol levels

c. Effective at lowering postprandial hyperglycemia

d. Increases insulin sensitivity of adipose tissue, skeletal muscle, and liver

e. Effective sulfonylurea alternative in patients with renal impairment or sporadic mealtimes

sulfonylureas in patients with renal impairment or sporadic mealtimes

e. Effective sulfonylurea alternative in patients with renal impairment or sporadic mealtimes

sulfonylureas in patients with renal impairment or sporadic mealtimes

3. Which would be an ideal goal for Javier to achieve for his hemoglobin A1C level?

a. 5.5

b. 6.5

c. 7.5

d. 8.5

b. 6.5

4. Javier's periodontal problems are the result of his diabetes. Patients with uncontrolled or undiagnosed diabetes are more prone to periodontal problems.

a. Both statements are true.

b. Both statements are false.

c. The first statement is true; the second statement is false.

d. The first statement is false; the second statement is true.

d. The first statement is false; the second statement is true.

5. All of these treatment modifications would be appropriate for Javier except which of the following?

a. Treat any infection aggressively.

b. Schedule appointments before mealtime.

c. Approach surgical therapy with caution to avoid tissue trauma.

d. Utilize stress reduction protocol during dental appointments.

e. Use caution with drugs such as epinephrine, glucocorticoids, or opioid analgesics.

b. Schedule appointments before mealtime.