Diabetes Mellitus: Understanding the Condition

Diabetes Mellitus

• A chronic health condition that affects how the body turns food into energy.
• The body breaks down most food into sugar (glucose), releasing it into the bloodstream.
• When blood sugar levels rise, it signals the pancreas to release insulin, which acts as a key to let blood sugar into the body's cells for energy.

Type 1 Diabetes

• Also known as juvenile diabetes, usually diagnosed in children and young adults.
• Only 5% of people have this disease, characterized by an autoimmune destruction of the insulin-producing beta cells in the pancreas.
• Individuals with type 1 diabetes produce little to no insulin, requiring insulin injections to manage blood sugar levels.
• Insulin resistance is not a defining feature of type 1 diabetes.
• The disease involves multiple genes, each contributing a small amount to the overall risk (polygenic).
• The strongest genetic associations are with the human leukocyte antigen (HLA) region on chromosome 6, particularly HLA-DR3 and HLA-DR4 alleles.

Type 2 Diabetes

• The most common form of diabetes (about 90% of cases).
• The 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.
• Exposure to viruses and other environmental factors may contribute to the development of type 2 diabetes.

Causes and Risk Factors

• Weight and age
• Fat distribution
• Physical inactivity
• Family history
• Blood lipid levels
• Prediabetes
• Polycystic ovaries

Diagnosis

• A blood sample is taken after an 8-hour fast to determine blood sugar levels.
• 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.
• A level of 126 mg/dL or higher on two separate tests indicates diabetes.
• A blood test for antibodies is used to distinguish between type 1 and type 2 diabetes.
• The A1C test is a cumulative sugar test that provides information about average blood glucose levels over the past 3 months.

Managing Type 1 Diabetes

• Self-monitoring: patients with type 1 diabetes should learn to record their blood glucose levels.
• Lifelong insulin therapy: managed by taking insulin injections.

Managing Type 2 Diabetes

• Maintain an ideal diet and exercise.
• Use of metformin as the optimal first-line drug unless contraindicated.
• Ultimately, insulin therapy alone or with other agents may be needed to maintain blood glucose control.

Oral Manifestations

• Dry mouth (xerostomia)
• Tooth decay and root caries
• Altered taste
• Thrush
• Gingivitis and periodontal disease
• Burning sensation
• Ulcers
• Gum disease: diabetes can make gums more prone to infections.
• Dry mouth: diabetes can reduce saliva production, leading to more cavities and mouth sores.
• Thrush: high blood sugar can promote the growth of fungi in the mouth.
• Slow healing: cuts or surgeries in the mouth may heal slower and get infected more easily.
• Burning mouth syndrome: signs include a burning sensation in the mouth.

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

• Hyperglycemia:
  • Assess the patient's blood glucose level and signs of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).
  • Stop any dental procedure immediately.
  • Ensure the patient is hydrated and comfortable.
  • Seek medical assistance if necessary.
• Hypoglycemia:
  • Assess the patient's blood glucose level and signs of hypoglycemia.
  • 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.
  • Recheck the blood glucose level after 15 minutes and repeat carbohydrate administration if necessary.
  • Call emergency medical services (EMS) if the patient is unconscious or unable to swallow.