1. 1 Clinical Case Presentation Building Blocks of Life Case # 6 Diabetes Mellitus Type 1 Building Blocks of Life Case # 6 Diabetes Mellitus Type 1

2. 2 Template for CCP Chief Complaint (CC) History of Chief Complaint (HCC) Medications (M) Social History (SH) Family History (FH) Dental History (DH) Medical History (MH) Review of Systems (RS) Diagnosis -Risk Assessment (DRA) Differential Diagnosis (DD) Treatment (Tx) Prognosis (PR) Chief Complaint (CC) History of Chief Complaint (HCC) Medications (M) Social History (SH) Family History (FH) Dental History (DH) Medical History (MH) Review of Systems (RS) Diagnosis -Risk Assessment (DRA) Differential Diagnosis (DD) Treatment (Tx) Prognosis (PR)

3. 3 Patient 45 year old male Chief Complaint (CC) I have a broken back tooth and it is painful to chew. I have not been able to sleep for the past two days. History of Chief Complaint (HCC) One week ago, Mr. Murray was eating at a local restaurant. He bit into a hard piece of bread and broke off a piece of his tooth. There had been a restoration in the molar previously. Medications Rapidly acting (Humalog) and slow acting (Lente) insulins

4. 4 Social History (SH) Married with two children. He is gainfully employed as an attorney. He does not smoke and has the occasional alcoholic drink. He drinks 6 to 10 cups of coffee a day. Family History (FH) Mother had history of type 1 diabetes mellitus and she died from renal failure at age 40. Paternal grandfather had prostate cancer. His teenage son suffers from asthma. Dental History (DH) Mr. Murray has regular dental check ups. There is no periodontal disease or caries. His last check up was 3 months ago. He had four impacted wisdom teeth removed at age 21. Medical History (MH) Type 1 diabetes mellitus for 20 years. He has no other medical history. Mr. Murray takes several insulin injections every day. He has had mild, peripheral retinopathy in his right eye for the past 5 years. He has no impairment of vision. He has no other complications. His last glycohemoglobin determination was 6.5%. He saw his physician last month for a routine checkup.

5. 5 Review of Systems (RS) Cardiovascular – Blood Pressure, 130/75. Pulse 76. Respiratory – Rate 17/min. Nervous – No obvious neuropathology. However, the patient is dental phobic and scared of surgery. He has seen the movie, Marathon Man, 4 times. Endocrine – Type 1 diabetes mellitus Renal – BUN 15 mg/ml (8 to 23 mg/ml); creatinine 0.8 mg/ml (0.6 to 1.2/dL) Gastrointestinal - unremarkable Skin and mucosa – Color and texture of skin and mucosa WNL. No persistent lesions or moles. Osteoarticular – WNL

6. 6 Diagnosis of Diabetes Mellitus Fasting blood glucose Glucose tolerance test Family history Signs and symptoms Fasting blood glucose Glucose tolerance test Family history Signs and symptoms

7. 7 Dental Management of IDDM Modification of insulin dose, if needed Determine dietary and insulin regimen prior to treatment Obtain most recent glycohemoglobin determination Have glucose or other readily absorbable form of carbohydrate available Determine need for antibiotics Know the signs and symptoms of profound hypoglycemia (A first-rate medical emergency) Have a glucometer, test strips, and sterile lancets available to test patient’s blood glucose If patient feels nauseous, weak, or has abdominal cramps or flu-like symptoms, as patient to test for ketones. Modification of insulin dose, if needed Determine dietary and insulin regimen prior to treatment Obtain most recent glycohemoglobin determination Have glucose or other readily absorbable form of carbohydrate available Determine need for antibiotics Know the signs and symptoms of profound hypoglycemia (A first-rate medical emergency) Have a glucometer, test strips, and sterile lancets available to test patient’s blood glucose If patient feels nauseous, weak, or has abdominal cramps or flu-like symptoms, as patient to test for ketones.

8. 8 Treatment and Prognosis Insulin Weight control Diet and exercise Target glycohemoglobin to 6.0% One hour postprandial glucose excursions Progression to complications is related to HbA 1c Retinopathy (eye) Neuropathy (nerve) Nephropathy (kidney) Periodontal disease Treatment and Prognosis Insulin Weight control Diet and exercise Target glycohemoglobin to 6.0% One hour postprandial glucose excursions Progression to complications is related to HbA 1c Retinopathy (eye) Neuropathy (nerve) Nephropathy (kidney) Periodontal disease

9. 9 Thank You