By kraisorn inphiban

Diabetes mellitus

Introduction
Classification diabetes mellitus
Disease progression
Diagnosis
Treatment
Complication
Dental management

Introduction
Pancrease
Islet of langerhans cell
Insulin
Glucose

Introduction

Introduction
Hyperglycemia

Normal 65-110 mg/dl

Abnormal 126 mg/dl

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

Classification diabetes mellitus

Primary diabetes mellitus

1.IDDM(Type I diabetes)
-Genetic
-Autoimmune

2.NIDDM(Type II diabetes)
-Genetic
-Obesity

Classification diabetes mellitus

Secondary diabetes mellitus
1.Injury of pancrease
-Infection of pancrease

-Hemochromatosis

2.Endocrine disorder
-Cushings syndrome
-On steroid

Classification diabetes mellitus

Secondary diabetes mellitus

Acromegaly
Pheochromocytoma
Glucagonoma
Somatostatinoma

3.Insulin resistance

Classification diabetes mellitus

1.IDDM(Type I diabetes)
2.NIDDM(Type II diabetes)

Classification diabetes mellitus

IDDM

Classification diabetes mellitus

NIDDM

Classification diabetes mellitus

IDDM
35%
<25 year
Female=male
Normal weight
Severe

NIDDM
65%
>40 year
Female>male
Obesity
Not severe

Classification diabetes mellitus

IDDM
Decrease insulin
Rapid onset
Ketoacidosis
common

NIDDM
Normal or
increase insulin
Slow onset
Ketoacidosis rare

Classification diabetes mellitus

IDDM
Microangiopathy
Family history
commom

NIDDM
arteriosclerosis
Family history
rare

Disease progression
1.Prediabetes
Present abnormal glucose level

2.Latent chemical diabetes

asymptomatic
Normal (FBS)
Normal Glucose tolerance
microangiopathy

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

- No drug before surgery

- D5W IV

Surgery
Monitor blood sugar level
Insulin every 6 hrs
Drug

Consultation