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Diabetes Mellitus
You will receive 2 unit(s) of continuing education credit upon successful completion of this course. The registration fee is only $70.00

More medical than dental in application, this course provides the dental professional with an overview of the physiologic effects of diabetes and how to recognize and treat the needs of the diabetic patient.


Author:

Jacob Fleischmann, MD  Show/Hide Bio...



Learning Objectives:


Upon completion of this course you will be able to do the following:

  1. Understand and offer the special consideration required while treating the diabetic patient in the dental office. 
  2. Identify the danger signals in the diabetic patient under dental treatment. 
  3. Cope with any possible emergency for the diabetic patient that may arise in the dental office. 
  4. Identify which islet cells produce insulin. 
  5. Compare the results of tight glucose control and poor glucose control in the diabetic patient. 
  6. Explain the cause of diabetic foot ulcers. 
  7. List which insulins can cause allergic reactions. 
  8. Identify the best way to monitor glucose control.
  9. List a category of drugs that can mask hypoglycemia.

Abstract:
This material is a comprehensive look at diabetes mellitus and is more medical than dental in its application. It is important, however, to understand the physiologic effects that accompany this disease and how it may influence the dental treatment of the patient. The most important detail is the kinetics of the insulin used by the patient. Dental procedures should be avoided during periods of peaked insulin activity. For the most part, early morning appointments are best. The regulation of food intake prior to and after dental manipulation is an important consideration. Patients with uncontrolled diabetes should delay dental treatment because of their inability to deal well with infections. The dentist should be prepared for hypoglycemia symptoms and be able to administer the proper preventative solutions.


Outline:
COURSE OUTLINE
  1. Introduction

  2. Physiology

    1. Exocrine Function

    2. Endocrine Function

      1. Insulin

      2. Glucagon

      3. Other Pancreatic Islet Cell Hormones

  3. Epidemiology

    1. Insulin-dependent (Type I)

    2. Non-insulin dependent (Type II)

    3. Secondary

    4. Impaired glucose tolerance

    5. Gestational diabetes

  4. Pathophysiology

    1. IDDM

    2. NIDDM

  5. Clinical Disease

  6. Diagnosis

    1. IDDM

    2. NIDDM

    3. Impaired Glucose Tolerance

    4. Gestational

    5. Glycosylated hemoglobin measurements

  7. Complications

    1. Acute Metabolic

      1. Diabetic ketoacidosis

      2. Non-ketotic hyperosmolar coma

    2. Late

      1. Circulatory abnormalities

      2. Retinopathy

      3. Nephropathy

      4. Neuropathy

      5. Foot ulcers

      6. Infections

      7. Skin manifestations

  8. Therapy

    1. IDDM

    2. NIDDM

  9. Specific Therapy Modes

    1. Diet

    2. Exercise

    3. Insulin

    4. Oral Hypoglycemic Agents

    5. Monitoring

    6. Hypoglycemia

    7. Newer Therapies

  10. Dental Management

References:
  1. Ganong WF: Review of Medical Physiology, 16th ed. Norwalk, Appleton & Lange, 1993, pp 302  332.
  2. Foster DW: Diabetes Mellitus, in Harrison's Principles of Medicine, 13th ed. Isselbacher KJ et al eds. New York, McGraw-Hill, 1993, pp 1979 - 2000.
  3. Nathan DM: Diabetes Mellitus, in Scientific American Medicine, Rubenstein E and Federman DD eds. New York, Scientific American Inc., 1993, section 9, chapter IV, pp 1 - 27.
  4. Orland MJ: Diabetes Mellitus, in Manual of Medical Therapeutics, 27th ed. Woodley M and Whelan A eds. Boston, Little, Brown and Co., 1992, pp 375 - 399.
  5. Terezhalmy GT: Dental correlations, Diabetes Mellitus, in InternalMedicine for Dentistry, 2nd ed. Rose LF and Kaye D eds., 1990, pp ll53-155




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