Diabetes Mellitus

Almost every cell membrane needs insulin to enable glucose penetration. 

Our body need insulin for 30-50 units per day.

• Polyuria ฉี่เยอะ
• Polydipsia จึงหิวน้ำบ่อย
• Polyphagia กินเยอะ
• Weight loss แต่น้ำหนักลด

1. Having major symptoms + 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)

65-110 mg/dL

110-125 mg/dL

GOTT ≥ 140 mg/dL

• HbA1c (glycosylated hemoglobin)
• It should be < 6.5 or 7 % in good glycemic control patients.

Beta cell destruction or defect in beta cell function which lead to absolute insulin deficiency

• 1. Supply insulin by injection
• 2. Pancreas or beta cell transplantation

Peripheral tissues lose responsiveness to insulin aka insulin resistance (the insulin level is normal)

• 1. Change in physics activity and diet, and lose weight
• 2. Oral anti-diabetic drugs

Pregnant women

It is temporary but sometime causing type II DM.

• 1. Hypoglycemia
• 2. Infection and poor wound healing
• 3. Accelerated periodontal disease
• 4. Insulin reaction
• 5. Organ damage

RPG < 60 mg/dL

shaky, tremulous, heart pounding, anxious, nervous, weak, tried, warm, difficulty in thinking, slurred speech, seizure, coma, death

• Comfortable position
• Administer oral carbohydrate

• Supin position, legs elevated
• Administer:
• - dextrose IV
• - glucose’s IM
• - transmucosal sugar (absorb sugar through oral mucosa)

Type I DM

High level of plasma glucose and ketone bodies

Type II DM

• Eating normal meals before apt
• schedule apt in the morning
• prepare sugar sources
• may require increase in insulin in aggressive management of infection

• FPG < 200 mg/dL
• (> 200; may extract easy tooth)