The Dental Patient with Diabetes

Chapter Fourteen - Prevention and Treatment of DM

Chapter 1: Glucose Metabolism and Hormonal Regulation Review

Chapter 2: Diabetes Mellitus

Chapter 3: Diabetes Mellitus Type 1

Chapter 4: Diabetes Mellitus Type 2

Chapter 5: Gestational Diabetes Mellitus (GDM)

Chapter 6: Pre Diabetes: Impaired Glucose Homeostasis

Chapter 7: Other Specific Types of Diabetes

Chapter 8: Diagnosing Diabetes

Chapter 9: Diagnosis

Chapter 10: Glucose Monitoring

Chapter 11: Complications of Diabetes

Chapter 12: The Dental Patient with Diabetes

Chapter 13: Successful Intervention of Diabetic Emergencies

Pharmacological
Intervention

Oral Hypoglycemic
Agents

Thiazolidinediones
(Actos, Avandia)

Glucosidase Inhibitors
(Precose, Glyset)

Combination
Medications

Chapter 15: Diabetes Medications

Chapter 16: Conclusion

Glossary

Appendices

References

Post Examination

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Pharmacological Intervention

Insulin

Normally produced by the ß-cells of the pancreas, insulin assists in the diffusion of glucose into the cell. When there is no insulin (or relatively little) glucose cannot enter the cell and be converted into energy. For individuals who do not produce insulin, insulin injections are necessary to balance the amount of glucose in the blood. Insulin cannot be taken orally because stomach acid will destroy it before it is effective. (3,19,23,25,26)

Persons with Type 1 must have insulin injections to live. Type 2 diabetics may take insulin if diet, exercise and/or oral hypoglycemics alone do not control blood sugar fluctuations. The amount and type of insulin will vary among individuals depending on sensitivity to insulin, activity level and lifestyle. 100 percent of Type 1 diabetics require insulin and approximately 35 percent of Type 2 diabetics require insulin.

Source

Original sources of insulin were either bovine or porcine. Today, there is a human source available. The human insulin source is available by through recombinant DNA techniques (a chemical process that makes it possible to produce unlimited amounts of insulin).

Table 8: Common Subcutaneous Insulin Pharmacodynamics (3,48)

Action	Type	Onset	Peak	Duration
Rapid	Aspart (Novolog) Lispro (Humalog) Glulisine (Apridra)	0.25 hours	0.5 - 1.5 hours	3 - 6 hours
Short	Regular	30 minutes	2.5 - 5 hours	6 - 8 hours
Intermediate	NPH Lente	1 hour 2 hour	3 - 6 hours 4 - 8 hours	11 - 16 hours 12 - 18 hours
Long Acting	Ultralente Glargine (Lantus)	4 - 6 hours 1 - 2 hours	12 - 16 hours Peakless	Up to 36 hours 24 hours
Mixed Insulins Intermediate + Short Acting	70/30 70% NPH/ 30% Regular	30 minutes	1 - 4 hours	4 - 30 hours
	50/50 50% NPH/ 50% Regular	30 minutes	1 - 4 hours	4 - 15 hours
Intermediate + Rapid Acting	Humalog Mix 75/25 75% NPL / 25% Lispro	0.25 hours	0.5 - 6.5 hours dual peaks	24 hours
Intermediate + Rapid Acting	Novolog Mix 70/30 70% NPA / 30% Aspart	0.25 hours	1 - 4 hours dual peaks	24 hours

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