Question 1

Type I and type II diabetics are at greater risk for caries.This risk is attributed to the higher concentration of glucose in their saliva.

Accepted Answer

The increased risk that a diabetic has for caries is due to xerostomia.A decrease in salivary flow can lead to mouth ulcers,inflamed tongue or mucosal tissues,and tooth deterioration.The complications of xerostomia are a result of the lack of its normal functions: lubricating,cleansing,regulating pH,destroying microorganisms and their products,and maintaining the integrity of oral structures.Uncontrolled diabetes produces a pronounced susceptibility to dental caries,which is caused mainly by decreased salivary flow (xerostomia)related to fluid loss.The loss is secondary to an increase in urination that occurs because of poor utilization of carbohydrates and the glucose that is excreted via the kidneys (water follows glucose).

Question 2

The mechanism of action of the sulfonylureas includes _____ of the release of insulin from the beta cells of the pancreas,_____ of glucose from the liver and serum glucagon levels,and a(n)_____ in the sensitivity of the target tissues to insulin.

Accepted Answer

For many years,the sulfonylureas were the only orally active agents used to manage diabetes.Second-generation sulfonylureas have replaced first-generation sulfonylureas because they are less toxic and easier to dose than first-generation sulfonylureas.The mechanism of action of sulfonylureas includes stimulation of the release of insulin from the beta cells of the pancreas,reduction of glucose from the liver and serum glucagon levels,and an increase in the sensitivity of the target tissues to insulin.

Question 3

Which form of insulin has a faster onset of action as a consequence of exchanging two amino acids in the structure of human insulin?

Accepted Answer

Lispro,a new insulin,is made by exchanging two amino acids in the structure of human insulin.This change results in an insulin with a faster onset of action.Pork insulin differs from human insulin by two amino acids,but it does not have the characteristics of lispro.The other choices have the same peptide sequence as human insulin but are complexed with different ingredients to alter the onset and duration properties of the molecule.

Question 4

Which oral antidiabetic agent produces lactic acidosis as a significant adverse effect?

Accepted Answer

The biguanides,such as metformin,can cause lactic acidosis as a side effect.Metformin is contraindicated in patients who have these conditions or are fasting.Tolbutamide (Orinase)is a sulfonylurea,repaglinide (Prandin)is a meglitinide,acarbose is an a-glucosidase inhibitor,and pioglitazone (Actos)is a thiazolidinedione.

Question 5

Which of the following choices is recommended for the treatment of hypoglycemia if the patient is unconscious and lacks a swallowing reflex?

Accepted Answer

Intravenous dextrose (50%)is the treatment of choice for hypoglycemia if the patient is unconscious and lacks a swallowing reflex.Intravenous glucose fluids and glucagon can be administered.When the patient is awake in the early stages of hypoglycemia,the treatment consists of any of the following: fruit juice,cake icing,glucose gel,or soluble carbohydrates.

Question 6

Diabetic gastroparesis can be treated with

Accepted Answer

Diabetic gastroparesis is atony of the gastrointestinal (GI)tract and is a consequence of diabetic neuropathy.It is treated with metoclopramide,which increases gastric motility.Amitriptyline is a tricyclic antidepressant.Carbamazepine is an antiepileptic drug.Ranitidine is an H₂-receptor antagonist.

Question 7

Insulin is usually administered

Accepted Answer

The major differences among the currently used types of insulin are their onset and duration of action.Insulin is usually administered by subcutaneous injection.Its large molecular size prevents it from being absorbed from the GI tract.

Question 8

Which of the following symptoms of hypoglycemia can be explained by glucose deprivation of the brain rather than the adrenal glands: (1)blurred vision, (2)incoherent speech, (3)sweating, (4)tachycardia?

Accepted Answer

Symptoms of hypoglycemia caused by glucose deprivation of the brain include headache,blurred vision,mental confusion,incoherent speech,and (eventually)coma,convulsions,and death.Symptoms of hypoglycemia that can be explained by an increased release of epinephrine from the adrenals include sweating,weakness,nausea,and tachycardia.

Question 9

The primary goal of treating diabetes is to maintain hemoglobin A₁C levels

Accepted Answer

An abundance of conclusive evidence from long-term,randomized clinical trials has proven that maintaining hemoglobin A₁C levels as close to the normal range decreases the incidence and progression of microvascular complications of type 2 diabetes.For every percentage point drop in hemoglobin A₁C decreases the risk of microvascular complications by 40%.The American Diabetes Association Standards of Medical Care in Diabetes recommends a hemoglobin A₁C level <7% in order to reduce the incidence and progression of microvascular and macrovascular complication in patients with both type 1 and type 2 diabetes.

Question 10

Insulin resistance develops because of prolonged _____ and resulting _____.

Accepted Answer

Tissue insensitivity to insulin,a deficiency of the pancreas's response to glucose,and obesity result in impaired insulin action.In the presence of hyperglycemia,the resistance of the tissues to insulin and the impaired b cells' response are exaggerated.Hyperglycemia and resulting hyperinsulinemia lead to insulin resistance.

Question 11

Which of the following statements is true of metformin?

Accepted Answer

Metformin (Glucophage)lowers blood glucose but,used alone,does not produce hypoglycemia.Metformin is a member of the biguanide group of antidiabetic agents.It increases hepatic and peripheral insulin sensitivity,resulting in decreased hepatic glucose production.It also increases peripheral skeletal muscle glucose uptake.Lactic acidosis,its most serious side effect,is rare.

Question 12

The most common adverse reaction associated with any insulin product is

Accepted Answer

Besides hypoglycemia,inhaled insulin can cause shortness of breath,dry mouth,and cough.The dental health care worker should be most concerned about a hypoglycemic reaction in the dental patient with diabetes who takes insulin.This reaction can be caused by an unintentional overdose of insulin,failure to eat,or increased exercise or stress.

Question 13

Human insulin is made from pork insulin by

Accepted Answer

Pig insulin has only two amino acids that are different from those in human insulin.The protein can be converted by transpeptidation.Recombinant DNA synthesis and gene splicing in E.coli refer to the same process,which is the process for synthesizing human insulin from scratch.Transamination and glycosylation are two biochemical processes that are not used in making human insulin from pork insulin.

Question 14

Which of the following statements is true regarding systemic complications of diabetes?

Accepted Answer

Neuropathy is a complication of diabetes.It leads to reduced and sometimes absent feelings,especially in the lower extremities.Gangrene can occur in peripheral extremities,especially the feet and legs.This occurs because of the deficiencies of diabetes,depressed immunity,less effective white blood cells,microvascular changes,and neuropathy.Hyperlipidemia and atherosclerosis are more common in these patients.

Question 15

All of the following are likely reasons why diabetics have a higher incidence of periodontal disease except which one?

Accepted Answer

Diabetes causes a thickening of the capillary basement membrane,not a decrease in its integrity,which may compromise the transport and exchange functions of the capillaries.Enhanced collagenase activity will enhance the breakdown of connective tissue.Changes in glucose tolerance factor increase glucose levels.Microangiopathy of the tissues impairs circulation.Altered PMN function decreases the innate immune response.All of these are considered candidates for the etiology of diabetes-induced periodontal disease.

Question 16

Adverse reactions to metformin occur primarily in the

Accepted Answer

Lactic acidosis,the most serious side effect with metformin,is rare.Predisposing factors to lactic acidosis include alcoholism,binge drinking,and renal or hepatic dysfunction.Adverse reactions are primarily related to the GI tract (30%)and include anorexia,dyspepsia,flatulence,nausea,and vomiting.It can produce headache and interfere with vitamin B₁₂ absorption.It accumulates in renal and hepatic impairment.

Question 17

More and more cases of type II diabetes are being reported in persons younger than 20 years because of

Accepted Answer

Fast foods,video games,and television have replaced physical activity,and obesity,a major risk factor for developing type II diabetes,is on the rise.More and more cases of type II diabetes in young persons are being attributed to a much more sedentary lifestyle and lack of exercise.

Question 18

Which of the following pancreatic hormones promotes fuel mobilization?

Accepted Answer

Glucagon promotes fuel mobilization.Insulin promotes fuel storage.The functions of IAPP (amylin)and pancreatic peptide have not yet been elucidated.

Question 19

Which of the following statements is true concerning oral surgical procedures for the adult patient with diabetes?

Accepted Answer

After surgery,the patient should receive an adequate caloric intake to prevent hypoglycemia.With general anesthesia,patients are often told to eat nothing by mouth and should take one half of their usual dose of insulin and receive intravenous 5% glucose in distilled water.The patient should eat a normal breakfast and take the regular antidiabetes medication prior to the procedure.

Question 20

Contributing factors to gangrene in the extremities of diabetic patients include

Accepted Answer

Poor eyesight and reduced sensation in the extremities increase the risk of injury that can lead to infection.Poor circulation makes it more difficult for the immune system and systemic drug therapy to reach the site of infection.All of the choices contribute to gangrene in the extremities of diabetic patients.

Quiz 18: Drugs for the Treatment of Diabetes Mellitus

Type I and type II diabetics are at greater risk for caries.This risk is attributed to the higher concentration of glucose in their saliva.

The mechanism of action of the sulfonylureas includes ___ of the release of insulin from the beta cells of the pancreas,_ of glucose from the liver and serum glucagon levels,and a(n) ___ in the sensitivity of the target tissues to insulin.

Which form of insulin has a faster onset of action as a consequence of exchanging two amino acids in the structure of human insulin?

Which oral antidiabetic agent produces lactic acidosis as a significant adverse effect?

Which of the following choices is recommended for the treatment of hypoglycemia if the patient is unconscious and lacks a swallowing reflex?

Diabetic gastroparesis can be treated with

Insulin is usually administered

Which of the following symptoms of hypoglycemia can be explained by glucose deprivation of the brain rather than the adrenal glands: (1) blurred vision, (2) incoherent speech, (3) sweating, (4) tachycardia?

The primary goal of treating diabetes is to maintain hemoglobin A₁C levels

Insulin resistance develops because of prolonged _ and resulting _.

Which of the following statements is true of metformin?

The most common adverse reaction associated with any insulin product is

Human insulin is made from pork insulin by

Which of the following statements is true regarding systemic complications of diabetes?

All of the following are likely reasons why diabetics have a higher incidence of periodontal disease except which one?

Adverse reactions to metformin occur primarily in the

More and more cases of type II diabetes are being reported in persons younger than 20 years because of

Which of the following pancreatic hormones promotes fuel mobilization?

Which of the following statements is true concerning oral surgical procedures for the adult patient with diabetes?

Contributing factors to gangrene in the extremities of diabetic patients include

Quiz 18: Drugs for the Treatment of Diabetes Mellitus

Type I and type II diabetics are at greater risk for caries.This risk is attributed to the higher concentration of glucose in their saliva.

The mechanism of action of the sulfonylureas includes _____ of the release of insulin from the beta cells of the pancreas,_____ of glucose from the liver and serum glucagon levels,and a(n) _____ in the sensitivity of the target tissues to insulin.

Which form of insulin has a faster onset of action as a consequence of exchanging two amino acids in the structure of human insulin?

Which oral antidiabetic agent produces lactic acidosis as a significant adverse effect?

Which of the following choices is recommended for the treatment of hypoglycemia if the patient is unconscious and lacks a swallowing reflex?

Diabetic gastroparesis can be treated with

Insulin is usually administered

Which of the following symptoms of hypoglycemia can be explained by glucose deprivation of the brain rather than the adrenal glands: (1) blurred vision, (2) incoherent speech, (3) sweating, (4) tachycardia?

The primary goal of treating diabetes is to maintain hemoglobin A₁C levels

Insulin resistance develops because of prolonged _____ and resulting _____.

Which of the following statements is true of metformin?

The most common adverse reaction associated with any insulin product is

Human insulin is made from pork insulin by

Which of the following statements is true regarding systemic complications of diabetes?

All of the following are likely reasons why diabetics have a higher incidence of periodontal disease except which one?

Adverse reactions to metformin occur primarily in the

More and more cases of type II diabetes are being reported in persons younger than 20 years because of

Which of the following pancreatic hormones promotes fuel mobilization?

Which of the following statements is true concerning oral surgical procedures for the adult patient with diabetes?

Contributing factors to gangrene in the extremities of diabetic patients include

The mechanism of action of the sulfonylureas includes ___ of the release of insulin from the beta cells of the pancreas,_ of glucose from the liver and serum glucagon levels,and a(n) ___ in the sensitivity of the target tissues to insulin.

Insulin resistance develops because of prolonged _ and resulting _.