What is the function of insulin?
How much our body need for a day?
Almost every cell membrane needs insulin to enable glucose penetration.
Our body need insulin for 30-50 units per day.
What are four major symptoms of DM?
Weight loss แต่น้ำหนักลด
There are three ways to give DM diagnosis.
+ random plasma glucose > 200 mg/dL
2. Fasting Plasma Glucose (FPG) > 126 mg/dL
(fasting since 8pm of the previous day)
3. Oral Glucose Tolerance Test (OGTT) > 200 mg/dL
(testing 2 hours after taking 75 mg Glucose)
FPG level in healthy person is...
Pt will have
Impared Fasting Glucose
when FPG is...
Pt will have
Imapred Glucose Tolerance
when GOTT is above...
GOTT ≥ 140 mg/dL
Which Test is used to track treatment of DM which reflect average blood glucose level over the preceding 90 days?
HbA1c (glycosylated hemoglobin)
It should be < 6.5 or 7 % in good glycemic control patients.
What happens with the pt with type I DM (insulin dependent or juvenile diabetes)?
Beta cell destruction or defect in beta cell function which lead to absolute insulin deficiency
What are two available treatment of type I DM?
1. Supply insulin by injection
2. Pancreas or beta cell transplantation
What happens with the patient with type II DM (non insulin dependent)?
Peripheral tissues lose responsiveness to insulin aka insulin resistance (the insulin level is normal)
What are two treatments of type II DM?
1. Change in physics activity and diet, and lose weight
2. Oral anti-diabetic drugs
Who will get
It is temporary but sometime causing type II DM.
What are five potential problems of pt with DM?
2. Infection and poor wound healing
3. Accelerated periodontal disease
4. Insulin reaction
5. Organ damage
Pts get hypoglycemia when their plasma glucose drops below...
RPG < 60 mg/dL
Signs and symptoms of hypoglycemia?
shaky, tremulous, heart pounding, anxious, nervous, weak, tried, warm, difficulty in thinking, slurred speech, seizure, coma, death
Treatment of hypoglycemia in conscious pt?
Administer oral carbohydrate
Treatment for hypoglycemia in
Supin position, legs elevated
- dextrose IV
- glucose’s IM
- transmucosal sugar (absorb sugar through oral mucosa)
Which type of DM relates to diabetic ketoacidosis?
Type I DM
How is the level of
in diabetic ketoacidosis pt?
High level of plasma glucose and ketone bodies
Which type of DM relates to nonketotic hyperosmolar coma?
Type II DM
Management to prevent insulin reaction?
Eating normal meals before apt
schedule apt in the morning
prepare sugar sources
may require increase in insulin in aggressive management of infection
How much FPG level that allow pt to get surgery?
FPG < 200 mg/dL
(> 200; may extract easy tooth)
Source: CMU (Aj. Nushada)