How will the anti-diabetic drugs work? Implication in dental procedure.

 

1. What is diabetes mellitus?

A metabolic disorder characterized by hyperglycemia, glycosuria, hyperlipidemia, negative nitrogen balance and sometimes ketonemia.

PATHOLOGICAL CHANGES:

Thickening of capillary basement membrane, increase in vessel wall matrix and cellular proliferation resulting in vascular complications like lumen narrowing, early atherosclerosis, sclerosis of glomerular capillaries, retinopathy, neuropathy and peripheral vascular insufficiency.

Two major type of diabetes mellitus are:

Type 1 [Insulin-dependent diabetes mellitus/ Juvenile onset diabetes mellitus]:

Type 2 [Noninsulin-dependent diabetes mellitus (NIDDM)/ maturity onset diabetes mellitus]:

2. Anti-diabetic drugs Classification:

3. How the Antidiabetic drug will act?

(A)

(B)

                (C)                          

 (D)

(E)

                                                                 

                                                                   (F)

4. Indications of oral hypoglycemic:

Indicated only in type 2 diabetes.

Most useful in patients with-

1. 40+ years at onset of disease.

2. Obesity at the time of presentation.

3. Duration of disease < 5 years when starting treatment.

4. Fasting blood sugar < 200 mg/dl.

5. Insulin requirement < 40 U/day.

6. No history of ketoacidosis, or any other complication.

Current recommendation is to institute metformin as soon as diagnosis of type 2 DM.

DPP-4 inhibitors are second line/ add on antidiabetic drugs.

5. Implications in dentistry:

• Dental extractions & other simple procedures under local anesthesia do not pose any special problems in diabetics, if blood sugar levels are well controlled.
• For more extensive dental procedures under GA, it is advisable to monitor urine & blood sugar levels & cover the perioperative period with regular insulin injected subcutaneously.
• Severe or uncontrolled diabetics may be given an i.v. infusion of regular insulin along with 5% glucose solution during the procedure.
• If blood sugar level poorly controlled prophylactic antibiotics should be given to cover dental procedure.