Amall Saleh Aaisha Alahwas Lili Wu DIABETES MELLITUS TYPE I & II.

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