Post on 24-Dec-2015
transcript
Amall Saleh Aaisha Alahwas Lili Wu
DIABETES MELLITUS TYPE I & II
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• 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
•Short/rapid acting insulins(15-20 min)• Intermediate acting insulins•Long acting insulins
Types of insulin
Mechanism of Action• Acts via specific membrane-bound receptors on target tissue
• Regulates metabolism of carbohydrate, protein, and fats
Living with Type I Diabetes
CASE STUDY
PATIENT PROFILEFemale;29 years old;AsianControlled Type I DiabetesDiagnosed 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 HistoryUpon initial diagnosis, oral medication for one monthSoon switched to insulin injection twice/dayDuring 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 DiabetesEndocrinologist visit once/monthA1C test every 3 monthsPodiatrist, optometrist visit once/yearIn 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 MANAGEMENTCoral 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 DRUGSo 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.
Levels of Glipizide may be decreased by Corticosteroids (orally inhaled) and (systemic)
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• Increased thirst• Frequent urination• Increased hunger• Weight loss• Fatigue• Blurred Vision• Slow-healing sores• Frequent infections
Q3
•Which type of diabetes is insulin-dependent? Which type is non-insulin dependent?
Answer
•Type I-insulin dependent•Type II- non-insulin dependent
Q4
•Which drug is used to treat Type I- DM?
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
• http://www.medicalnewstoday.com/info/diabetes/
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/#adam_000305.disease.treatment