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Introduction & Diabetes Mellitus (DM), Dental:, Medical: - Coggle…
Introduction & Diabetes Mellitus (DM)
✅ Definition
Metabolic disorder with sustained hyperglycemia due to:
Absolute/relative insulin deficiency
Insulin resistance
✅ Pathophysiology
Carbohydrates → glucose.
Pancreatic hormones:
Insulin (β-cells): ↑ glucose uptake, glycogen storage, protein & fat storage.
Glucagon (α-cells): ↑ glycogen → glucose.
Amylin (β-cells): slows gastric emptying, ↓ glucagon post-meals.
Other hormones: catecholamines, corticosteroids, thyroid hormone, GH, estrogen, progesterone.
In diabetes → glucose can’t enter cells → hyperglycemia, glucosuria, polyuria, polydipsia, weight loss, ketoacidosis.
✅ Complications of Chronic Hyperglycemia
Hypoglycemia / Hyperglycemia
Hyperosmolar Non-Ketotic Coma
Diabetic Ketoacidosis (DKA)
Neuropathy
Retinopathy
Nephropathy
Peripheral arterial angiopathy
Cardiovascular & cerebrovascular disease
✅ Classification of Diabetes
Type 1 (IDDM / Juvenile onset)
Onset before 30 yrs, autoimmune (anti-GAD antibodies).
Requires insulin for life.
Risk of ketoacidosis & hypoglycemia.
Variant: LADA (latent autoimmune diabetes in adults).
Type 2 (NIDDM / Maturity onset)
Onset >40 yrs, obesity, insulin resistance.
May progress to insulin requirement.
80% have metabolic syndrome (HTN, dyslipidemia, obesity).
Variant: MODY (genetic, onset <25 yrs).
Gestational Diabetes
Insulin resistance in 2nd/3rd trimester.
↑ risk of type 2 DM later.
Secondary Diabetes
Causes: steroids, thiazides, HIV drugs, pancreatitis, hemochromatosis, CF, Cushing’s, acromegaly.
✅ Signs & Symptoms
Lethargy
Polyuria, polydipsia
Weight loss
Recurrent infections (skin/oral/genital)
Behavioral changes
Abdominal pain, nausea/vomiting
Ketoacidosis, visual changes, paraesthesia
Renal failure, coma
✅ Oral Manifestations
Severe periodontitis
Oral candidiasis, mucormycosis
Severe abscesses
Paraesthesia (sign of hypoglycemia)
Burning mouth, dry mouth
Grinspan syndrome (DM + lichen planus + HTN)
✅ Lab Investigations
FPG ≥ 7.0 mmol/L → diabetic
RBG ≥ 11.1 mmol/L → diabetic
OGTT ≥ 11.1 mmol/L → diabetic
HbA1C for monitoring
✅ Management
✅ Hyperglycemia
Develops slowly, less dangerous than hypoglycemia.
Symptoms: weakness, nausea, dehydration, acetone breath, coma.
✅ Severe Complications
HONK (Hyperosmolar Non-Ketotic Coma): type 2 DM, high glucose, dehydration, risk of thrombosis. Tx: fluids, insulin, K+, heparin.
DKA (Diabetic Ketoacidosis): infection, missed insulin, dehydration → ketones, hyperventilation, hypotension, coma. Tx: fluids, insulin, K+, antibiotics.
Dental:
Pre-op assessment
Timing & glucose monitoring
Antibiotics if needed
Care with local anesthetics, sedation
Manage infections & wound healing
Controlled diabetics: safe for procedures
Poorly controlled: postpone elective surgery
Medical:
Diet & exercise
Oral drugs: Metformin, Sulfonylureas
Insulin (short/long/mixed)
Others: antihypertensives, aspirin, statins