Chapter 18: Diabetes Mellitus

Cells in pancreas that secrete hormones are known as _____

Isle of Langerhans (beta cells)

Two primary hormones secreted by Islets of Langerhans of the pancreas are _____ and _____

insulin, glucagon

_____ promotes fuel storage (glucose out of the blood— pack the bags), whereas _____promotes fuel mobilization in the body (glucose in the blood— unpack the bags)

Insulin, glucagon

Fasting blood sugar of 80-120 mg/dL

pre-diabetic pt

Other hormones secreted by the pancreas are _____and _____

islet amyloid polypetide (IAPP; amylin), pancreatic peptide

Diabetes Mellitus is a group of metabolic disorders characterized by persistent _____

hyperglycemia

a complete lack of insulin, autoimmune destruction of pancreatic cells. It causes ____, virus, environmental insults, some unknown factors, and w/out tx this type is fatal

Type I DM, infection

Levels of insulin does not reduce level of blood glucose. Causes include ____ have delayed or reduced response to glucose, insulin resistance → 2) insulin sensitivity (more needed insulin needed to produce a response), 3) “pooped out pancreas”, (4) Adipose tissues produce adipokines that impair glucose tolerance

Type 2, beta cells

_____ in DM can lead to mouth ulcers, inflammation of the tongue or mucosal tissues, and tooth deterioration.

Xerostomia

The proposed etiology for the periodontal changes seen in the pt with diabetes includes microangiopathy of the tissues, thickening of the capillary basement membranes, changes in _____, altered polymorphonuclear leukocyte function, and ____

glucose tolerance factor (more glucose), enhanced collagenase activity

Patients with diabetes often have an increased __________ rate due to reduced salivary flow and altered saliva composition.

caries

Less blood flow to oral cavity, infection more difficult to treat (antibiotic cannot reach site), prone to infection, more perio/periapical infections

Microvascular damage

Less ability to fight microorganisms, get infections more easily, periapical and periodontal abscesses

Altered immunity/white blood cell abnormality

Increased __________ in the oral environment can worsen diabetic control and increase insulin needs. Oral infections reduces diabetes control; more insulin needed. When infection is treated, better _____ (need less)

acidity , insulin control

__________ may present as numbness, burning, or tingling sensations in diabetic patients.

neuropathy

Diabetic patients are more prone to fungal infections such as __________ and mucormycosis.

candidiasis

__________ mouth syndrome is commonly reported in diabetic patients, though the cause is unknown.

Burning

Diabetes is associated with delayed and impaired __________ w/ oral trauma due to poor collagen formation.

healing

Cardiovascular complications in diabetes are associated with __________ and __________ damage. Also ____ which contributes to plaque buildup in arteries

macrovascular, microvascular, hyperlipidemia

The combination of vascular damage and hyperlipidemia increases the risk of __________ disease.

cardiovascular

Poor circulation in diabetic patients can lead to complications in the __________, __________, and __________ (think: what to always check)

feet, teeth, eyes

A diabetic patient with blurred vision is most likely experiencing __________ damage

retinal (retinopathy)

A patient reporting loss of feeling, pain, burning oral discomfort, tongue pain and tingling in the extremities is showing signs of diabetic

neuropathy

____ in diabetes mellitus is also a common systemic complication

Slow healing

The primary goal of treating diabetes is to maintain A1C levels as close to _____. American Diabetes Association recommends HbA1C below _____

normal as possible, 7%

Studies have proved that keeping A1C levels as close as possible to the normal range decreases the incidence and progression of ____ complications of type 2 diabetes. Early interventions also appears to contribute to a reduction in _____ complications

microvascular, macrovascular

Normal fasting blood glucose is less than __________ mg/dL. The goal fasting blood glucose range for diabetic patients is __________ to __________ mg/dL. A fasting blood glucose level of __________ mg/dL indicates need for clinical action.

<110, 80-120, 140

A normal HbA1c level is less than _____%, the goal HbA1c for diabetic patients is less than ______%, An HbA1c level greater than _____% indicates poor control and need for intervention

6, 7, 8

HbA1c reflects average blood glucose levels over approximately the past __________ months.

2-3 months

Every % point drop reduces microvascular damage complications reduces _____

40%

The major differences among the currently used types of insulin are ____ and _____. The older preparations were prepared from beef or pork pancreas, but _____ is now used exclusively

onset, duration of action, human insulin

The most common adverse reaction associated with any insulin product is _____. Inhaled insulin can also cause _____, _____, and cough

hypoglycemia, shortness of breath, dry mouth

The dental hygienist should be most concerned about a ______ in the dental pt with diabetes who takes insulin. This reaction can be caused by an unintentional insulin overdose (_____), failure to eat, or increase _____

hypoglycemic reaction, insulin shock, exercise or stress

Insulin must be administered by __________ injection due to large molecular size preventing it from being absorbed in the GI

subcutaneous

Symptoms that can be explained by a greater release of epinephrine from the adrenals include _____, weakness, _____ and ______

sweating, nausea, tachycardia

Symptoms caused by glucose deprivation of the brain include ____, blurred vision ____, incoherent speech, and eventually _____, convulsions, and ____. Tx deliver _____

headache, mental confusion, coma, death, glucose

Another side effect associated with insulin is an allergic reaction, usually caused by noninsulin contaminants. _____ at the injection site causes atrophy of the subcutaneous fatty tissue (the incidence of these reactions has decreased bc newer insulin preparations are _____ and bc of pt education about changing the _____

Lipodystrophy, purer, injection site

Novolog, Humalog, Admelog, Apidra are all ______

Rapid-acting insulin analogs

Novolin R and Humulin R are _____

short acting regular insulion

Insulin NPH (Humulin N and Novolin N) are _____

intermediate-acting insulin

Insulin detemir (Levemir), Insulin glargine (Lantus, Basaglar, Semglee), Insulin glargine (Tonjeo), and Insulin degludec (Tresiba) are _____

Long acting insulin analogs

Novolog Mix and Humalog Mix are ____

Pre-Mixed insulin combinations

Xultophy and Soliqua are _____

Long acting insulin/GLP-1 Receptor Agonist Combinations

The oldest group of antihyperglycemic drugs used to treat diabetes type 2, the ______, are also known as _____. The other nine groups are more precisely referred to as the ______ because they lower an elevated blood glucose value but do not produce hypoglycemia by themselves

sulfonylureas, oral hypoglycemic agents, antihyperglycemic

_____ MOC includes stimulation of the release of insulin from the B cells of the pancreas, reduction of glucose from the liver, reduction in serum glucagon levels, and increase in the sensitivity of the target tissues to insulin

Sulfonylureas

Metformin (Glucophage) belongs to the __________ class of oral antidiabetics.

biguanide

Metformin (Glucophage) lowers blood glucose but does NOT usually cause _______ alone

hypoglycemia

Meglitinides (Prandin, Starlix) stimulate insulin release from the pancreas and must be taken with ________, they also require functioning _____ cells to be effective.

meals, beta

Repaglinide may be a useful alternative to a _____ in patients with renal impairment or in patients who eat sporadically

sulfonylurea

Thiazolidinediones (Actos and Avandia) reduce _______ resistance in tissues. These drugs act on adipose tissue, skeletal muscle, and the ______

insulin, liver

Both ____ and _____ are US Food and Drug Administration (FDA) approved as monotherapy or in combination with metformin, a sulfonylurea, or insulin

Actos, Avandia

Alpha-glucosidase inhibitors (Precose and Glyset) work in the small intestine by blocking the ________ enzyme, which normally breaks down ________ into glucose. By slowing carbohydrate breakdown, these drugs delay _______ absorption and reduce __________ hyperglycemia after meals

alpha-glucosidase; carbohydrates; glucose; postprandial

GLP-1 receptor agonists are also known as __________ mimetics because they mimic the natural hormone __________ released from the __________ after meals.

incretin; GLP-1; gut (intestines)

These drugs (Trulicity and Byetta) increase __________ release in the presence of __________ and decrease __________ production, helping lower blood glucose levels.

insulin; glucose; glucagon