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Dealing With Diabetes

Dealing with diabetic patients?

If so, this course can't be beat. It's the dental clinician's answer book to such questions as:

  • What seven complications of diabetes can be revealed by a patient's history?
  • What three oral signs are associated with hyperglycemia?
  • What signs warn of a diabetic emergency?
  • What are the appropriate treatments for oral complications of diabetes?

Let's face it, an aging and increasingly overweight population means an increase in the number of diabetic patients walking through your door. A good understanding of this disease is mandatory to providing appropriate treatment. Our concise text, with its information-packed tables and charts, gives you this vital orientation. In fact, many of the charts are so useful, you'll want to post copies on your office bulletin board for quick reference.

Let's face it, an aging and increasingly overweight population means an increase in the number of diabetic patients walking through your door. A good understanding of this disease is mandatory to providing appropriate treatment. Our concise text, with its information-packed tables and charts, gives you this vital orientation. In fact, many of the charts are so useful, you'll want to post copies on your office bulletin board for quick reference.

"Had a near emergency recently. This booklet (Dealing With Diabetes) will be used as a chairside reference."

Annamarie Maskulinski, RDH
West Seneca, NY

Dealing With Diabetes

How to know what to order? This course comes as a booklet with the course and test all in one so you are only paying to take the test.  If you would like to receive an electronic copy of the booklet/test then choose our PDF email option! Would you rather receive a hard copy in the mail? Then choose the book/test option. Email courses will take their test online while those that choose the hard copy can either mail their test back in the envelop we provide for grading OR take your test right online for immediate grading.

Dealing With Diabetes

Dealing With Diabetes
(book and test) Traditional Hardcopy

3 Hours     $30.00

Dealing With Diabetes
(PDF and test (Email) Online Only

3 Hours     $30.00

Last reviewed: January 1, 2017
Expires: January 1, 2020

Dealing With Diabetes

About the Authors

Neil F. Goodman, MD, has a private endocrinology practice in Miami, Florida. He is also a Professor of Medicine (Reproductive Endocrinology) on the Voluntary Faculty, University of Miami School of Medicine, Miami, Florida. He is Board-certified in internal medicine, with a subspecialty in endocrinology and metabolism.

Dr. Goodman earned his MD at the Columbia College of Physicians and Surgeons in New York, New York. He is Chairman of the Reproductive Endocrinology Committee of the American Association of Clinical Endocrinologists. He has lectured extensively on reproductive endocrinology, polycystic ovary syndrome, fertility management, and menopausal hormone therapy. His publications include guidelines on menopause and on the diagnosis and treatment of hyperandrogenic disorders.

Wendy S. Hupp, DMD, is an Assistant Professor and the Director of Oral Medicine, Department of Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Florida. Dr. Hupp is a Diplomate of the American Board of Oral Medicine.

Dr. Hupp earned her DMD at the University of Pennsylvania School of Medicine. Her numerous presentations on clinical oral diagnosis, medicine, and pathology include those on oral cancer and tobacco cessation, aphthous ulcers, dental pharmacology, viral hepatitis, human immunodeficiency virus, seizure disorders, and women's health.

Dealing With Diabetes

Course Objectives

When you complete this course, you will take a written or online test that measures your ability to identify:

  1. Clinical classes of diabetes mellitus.
  2. Causes of and risk factors for diabetes.
  3. Physiologic complications of diabetes and their treatment.
  4. Methods of testing and diagnostic criteria for diabetes and prediabetes.
  5. Which patients should be screened for undiagnosed diabetes.
  6. Methods of managing and controlling blood glucose levels and emergencies.
  7. Precautions that dental professionals should take when treating diabetics.
  8. Oral complications of diabetes mellitus.

Dealing With Diabetes

Table of Contents

When you complete this course, you will take a written or online test that measures your ability to identify:

  • Chapter 1 Introduction
    What Is Diabetes?
    Epidemiology
    Myths About Diabetes
    Hope for the Future
    What You Can Do
  • Chapter 2 Pathophysiology of Diabetes
    Etiology and Risk Factors
    Physiologic Changes
    Cardiovascular Disease
    Diabetic Nephropathy
    Neuropathies
    Diabetic Retinopathy
    Oral Cavity Disease
    Biochemical Imbalances
    Complications of Pregnancy
  • Chapter 3 Diagnosis and Screening
    Initial Signs and Symptoms
    Laboratory Evaluations
    Patients Who Should Be Tested
    Prevention of Type 2 Diabetes
  • Chapter 4 Medical Management
    Basic Treatment Guidelines
    Blood Glucose Monitoring
    Blood Glucose Control
    Blood Glucose Emergencies
    Nutrition and Weight Loss
    Smoking
    Immunizations
    Cardiovascular Disease
    Diabetic Nephropathy
    Neuropathies Diabetic
    Retinopathy
    Oral Cavity Disease
    Pancreas Transplantation
  • Chapter 5 Dental Patient Management
    Patient History and Evaluation
    Blood Glucose Precautions
    Blood Glucose Emergencies
    Drugs That Affect Blood Glucose
    Adverse Drug Interactions
    Oral Complications of Diabetes
    Dentist-Physician Communication
  • Chapter 6 The Future of Diabetes
    Hormonal-Based Treatments
    Beta-Cell Transplantation
    Vaccine Research
    Insulin Developments
    DPP-IV Inhibitors
    Antibody-Based Treatment
    Genetic Research
    Ruboxistaurin-Based Treatment
    The Progress of Research
  • Appendix
    Definitions
    Information Sources
    Index
    Reference List

Dealing With Diabetes

Table of Contents

Physiologic Changes
The long-term hyperglycemia of chronic diabetes mellitus can result in damage to and failure of vital organs, including the heart, kidneys, blood vessels, eyes, and nerves. Brief descriptions of the most common complications of diabetes are given below; for treatment of these complications, see Chapter 4.

Cardiovascular Disease
Cardiovascular disease is a major cause of death for persons with diabetes, The term applies to several diseases that affect the heart and blood vessels; they include hypertension and peripheral vascular disease, as well as coronary artery, cerebrovascular, and congenital heart disease.

Diabetic Nephropathy
Disease of the kidneys occurs in up to 40% of diabetic patients. The earliest stage of nephropathy is persistent microalbuminuria (30 to 299 mg albumin in urine/24 hours). Without specific interventions, these patients eventually progress to macroalbuminuria (300 mg or greater/24 hours), also called overt nephropathy. About half of type 1 diabetic patients progress to end-stage renal disease within 10 years of developing overt nephropathy, and about one-fifth of type 2 diabetic patients progress to end-stage renal disease approximately 20 years after onset of overt nephropathy.

Neuropathies
The metabolic disturbances of diabetes lead to two forms of neuropathy characterized by progressive nerve fiber loss.
Diabetic autonomic neuropathy. This is manifested by dysfunction of the autonomic nervous system. The most clinically important form of diabetic autonomic neuropathy is cardiovascular autonomic neuropathy. This reduces cardiovascular function, which is associated with an increased risk of silent myocardial ischemia (see Definitions) and death. Diabetic autonomic neuropathy can also affect gastrointestinal and genitourinary organs, causing bladder and erectile dysfunction.
Diabetic peripheral (or somatic) neuropathy. Patients may suffer pain or have dulled sensitivity to touch in their feet or hands. In the later stages of this neuropathy, diabetic patients often develop foot ulcerations, which, in some cases, do not heal, become infected, and lead to toe or other amputations. In the United States, more than 50,000 diabetes-related, lower-extremity amputations are performed annually.

Diabetic Retinopathy
Among adults 20 to 74 years of age, diabetic retinopathy is estimated to be the most frequent cause of new cases of blindness. In the earliest stage of retinopathy, no vision loss occurs, but capillary walls balloon and lose their ability to control the passage of substances between the blood vessels and the retina. Subsequent formation of fatty deposits within the retina and swelling of the retina can lead to macular edema and vision loss. In addition, over the years, the damaged tiny blood vessels may close and be replaced by new capillaries that are weaker, leak blood, and block vision. These capillaries may cause growth of scar tissue, which, when it shrinks, can cause retinal detachment.
Vision-threatening retinopathy begins to affect most type 1 diabetic patients during the 2 decades after they have had diabetes for 5 years. Up to one-fifth of type 2 diabetic patients already have some stage of retinopathy at the time of diabetes diagnosis.

Oral Cavity Disease
Studies indicate that poorly controlled blood glucose and long-term diabetes are risk factors for periodontal disease. Studies also show that periodontal disease can, in turn, worsen blood glucose control. Diabetic patients are also prone to other oral diseases and often have special needs; these are discussed in Chapter 5.

Biochemical Imbalances
Uncontrolled hyperglycemia can lead to biochemical imbalances that cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome (see Table 10, Chapter 4).

Complications of Pregnancy
Prepregnancy diabetes that is poorly controlled before conception and during the first trimester can cause major birth defects in up to 10% of pregnancies and spontaneous abortions in up to 20% of pregnancies. Gestational diabetes mellitus (see Table 3) usually does not cause birth defects, but can lead to birth of an abnormally large baby and infant hypoglycemia immediately after birth.

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