Diabetes (2).pdf

Diabetes Mellitus Hamzah Safadi Serra Muhsin Hala Mousa Hoor Alnatsheh Layan Norhan Remal Introduction Diabetes is a chronic ( long-lasting) health condition that affects how your body turns food into energy. Your body breaks down most of the food you eat into sug...

Diabetes Mellitus Hamzah Safadi Serra Muhsin Hala Mousa Hoor Alnatsheh Layan Norhan Remal Introduction Diabetes is a chronic ( long-lasting) health condition that affects how your body turns food into energy. Your body breaks down most of the food you eat into sugar (glucose) and releases it into your body stream. When your blood sugar goes up, it signals your pancreas To release insulin. Insulin acts like a key to let the blood sugar into your body’s Cells for use as energy. With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should.  Introduction Type 1 Diabetes: Also known as juvenile diabetes Usually diagnosed in children and young adults Only 5% of people have this disease–Body does not produce insulin This form of diabetes is characterized by an autoimmune destruction of the insulin-producing beta cells in the pancreas. Individuals with type 1 diabetes produce little to no insulin and therefore require insulin injections to manage their blood sugar levels. Insulin resistance is not a defining feature of type 1 diabetes. Type 1 Diabetes does not follow a simple Mendelian inheritance pattern. It involves multiple genes, each contributing a small amount to the overall risk (polygenic). HLA Genes: The strongest genetic associations are with the human leukocyte antigen (HLA) region on chromosome 6, particularly HLA-DR3 and HLA-DR4 alleles. Introduction Type 2 Diabetes: Most common form of diabetes (about 90% of cases) Used to be called adult onset, non insulin dependent diabetes Body produces insulin, but does not use it properly In type 2 diabetes, the body's cells become resistant to the effects of insulin. Initially, the pancreas compensates by producing more insulin, but over time, it cannot keep up, leading to elevated blood sugar levels. Insulin resistance is a key characteristic of type 2 diabetes. Type 2 diabetes involves multiple genes, with no single gene being responsible for the disease. The inheritance pattern is polygenic and multifactorial. Variants in genes such as TCF7L2, PPARG, KCNJ11, and FTO are associated with increased risk. Introduction Monogenic diabetes is a rare condition resulting from mutations in a single gene. In contrast, the most common types of diabetes (type 1 and type 2) are caused by multiple genes (in addition to lifestyle factors in type 2 diabetes such as obesity for example). The role of insulin In the pancreas, there are pancreatic cells called islet cells that are responsible for producing hormones such as insulin and glucagon. These hormones help control the levels of glucose (sugar) in the blood. Insulin is produced by beta cells of the pancreas when blood sugar levels are too high. Glucagon, on the other hand, is produced by alpha cells of the pancreas when blood sugar levels are too low.  Genetics of diabetes Type 2 diabetes has a stronger link to family history and lineage than type 1. Studies of twins have shown that genetics play a very strong role in the development of type 2 diabetes. The inheritance pattern is polygenic and multifactorial.  Genetics of diabetes Disease Etiology and Incidence Monogenic forms of diabetes are caused by single gene variants and comprise 1 to 5% of all cases of diabetes in children and adults. HNF1A mutations cause a monogenic form of diabetes called maturity-onset diabetes of the young (MODY), and HNF1A single-nucleotide polymorphisms, comprising 30 to 65% of monogenic diabetes cases. Pathogenesis Monogenic diabetes is a heterogeneous group of conditions, each with a specific impact on the pancreatic islet β cell, ranging from impairing pancreatic development to dysfunction and impairments in insulin secretion. The HNF1A gene, originally described as coding for a hepatic nuclear factor, encodes transcription factors present in many tissues. Genetics of diabetes MODY stands for maturity-onset diabetes of the young, which is a group of conditions characterized by abnormally high blood glucose levels. Mutations in the HNF1A gene cause diabetes by lowering the amount of insulin that is produced by the pancreas. It allows insulin to be produced normally in childhood, but the amount of insulin reduces as you get older. HNF1A-MODY is caused by pathogenic variants in the HNF1A gene, with autosomal dominant inheritance due to HNF1α haploinsufficiency. Haploinsufficiency is when one copy of a gene is inactivated or deleted, and the remaining functional copy of the gene is not adequate to produce the needed gene product to preserve normal function. Symptoms Polyuria (Frequent urination) Polydipsia (Excessive thirst) Polyphagia (Hunger) Unexplained weight loss Fatigue Feeling irritable Having blurry vision Causes & risk factors The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — destroys the insulin-producing (islet) cells in the pancreas. Other possible causes include: 1. Genetics 2. Exposure to viruses and other environmental factors Causes & risk factors Weight & Fat Physical Family age distribution inactivity history Blood lipid Polycystic Prediabetes levels ovaries Summary Type 1 Type 2 HNF1A MODY Autoimmune disease Not an autoimmune disease Not an autoimmune disease Develops rapidly Develops slowly Develops slowly Pancreatic islet beta cells Low amounts of insulin are Mutation on the HNF1A gene incapable of secreting insulin secreted but are resisted and that leads to haploinsufficiency not used up Can be diagnosed at any age, Can be diagnosed at any age, Usually diagnosed young but is often diagnosed in young but is often diagnosed in adults adulthood children and teenagers Immediate need for insulin Can utilize other medications Can be treated with small doses injections and treatments prior to using of a group of tablets called insulin injections sulphonylureas prior to using insulin injections  Diagnosis A blood sample is going to be taken after you fast 8 hours. A blood sample will be taken after you don't eat (fast) overnight. A fasting blood sugar level less than 100 mg/dL is healthy. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If it's 126 mg/dL or higher on two separate tests, a person will be diagnosed with diabetes. In order to distinguish whether the patient has diabetes 1 or 2, a blood test for antibodies is going to be taken. In type 1 diabetes, the immune system makes antibodies that act against the cells in the pancreas that make insulin, and these antibodies can be detected in a blood test. The A1C test is a blood test (Cumulative Sugar test) provides information about your average levels of blood glucose over the past 3 months. It reflects the percentage of blood sugar attached to a protein called hemoglobin, which is present in red blood cells and responsible for oxygen transport in the blood. The A1C test can be used to diagnose type 2 diabetes and prediabetes. The A1C test is also the primary test used for diabetes management.  Managing type 1 diabetes Managing type 2 diabetes Self-monitoring: Lifelong insulin patients with type therapy: managed Maintain an ideal Use of metformin Ultimately, insulin 1 diabetes should by taking diet and exercise as the optimal first- therapy alone or line drug unless with other agents if learn how to injections. contraindicated needed to maintain record their blood blood glucose contr glucose levels. ol Oral manifestations Dry mouth Tooth decay & Altered taste Thrush (xerostomia) root caries Gingivitis Periodontal Burning Ulcers disease sensation Oral manifestations Gum Disease: Diabetes can make your gums more prone to infections. Signs: Red, swollen gums that bleed easily, bad breath, and in severe cases, loose teeth. What to Do: Keep your blood sugar levels under control, brush and floss regularly, and see your dentist for cleanings Dry Mouth: Diabetes can reduce saliva production. Problems: Dry mouth can lead to more cavities and mouth sores. What to Do: Drink plenty of water, use saliva substitutes, and avoid caffeine and smoking. Oral manifestations Thrush (Fungal Infection): High blood sugar can promote the growth of fungi in your mouth. Signs: White or red patches in your mouth, a burning feeling, and difficulty swallowing. What to Do: Maintain good oral hygiene, manage your blood sugar, and use antifungal medications if needed. Slow Healing: Cuts or surgeries in your mouth may heal slower and get infected more easily. What to Do: Keep your dentist informed about your diabetes, manage your blood sugar before and after dental procedures, and follow your dentist’s care instructions. Burning Mouth Syndrome: Signs: A burning sensation in your mouth. What to Do: Work with your healthcare provider to manage the pain and control your blood sugar. Dental management Guidelines for managing a diabetic patient in the dental office: Comprehensive medical history. Scheduling morning appointments. Blood glucose monitoring. Stress management. Managing xerostomia. Caries prevention. Post-operative care.  Emergency treatment Emergency Management of hyperglycemia: Assess the Patient: Check the patient's blood glucose level if a glucometer is available. Assess the patient for signs of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). Immediate Actions: Stop any dental procedure immediately. Ensure the patient is in a comfortable position, preferably sitting up. Keep the patient hydrated by offering water if they are conscious and able to drink. Seek Medical Assistance: Call emergency medical services (EMS) if the patient is severely hyperglycemic or showing signs of DKA/HHS. Monitor the patient's vital signs (pulse, respiration, blood pressure) while waiting for EMS.  Emergency treatment Emergency Management of hypoglycemia: Assess the Patient: Check the patient's blood glucose level if a glucometer is available. Confirm the signs and symptoms of hypoglycemia. Immediate Actions: Stop any dental procedure immediately. Have the patient sit or lie down to prevent falls or injuries. Administer Fast-Acting Carbohydrates: If the patient is conscious and able to swallow, give them 15-20 grams of fast-acting carbohydrates. Examples include: Glucose tablets or gel 4 ounces (120 ml) of juice or regular (non-diet) soda 1 tablespoon of sugar or honey Recheck the blood glucose level after 15 minutes. If it remains low, repeat the carbohydrate administration. Unconscious Patient: If the patient is unconscious or unable to swallow, do not give anything by mouth. Call emergency medical services (EMS) immediately. Administer a glucagon injection if available and you are trained to do so. Post-Event Management: Once the patient’s blood glucose level stabilizes, provide a snack containing complex carbohydrates and protein to maintain blood sugar levels. References Thompson & Thompson genetics in medicine (8th edition) [Medscape] https://emedicine.medscape.com/article/117739- overview?src=mbl_msp_ https://emedicine.medscape.com/article/117739- overview?src=mbl_msp_ https://www.mouthhealthy.org/all-topics-a-z/diabetes https://www.ncbi.nlm.nih.gov/books/NBK279127/