Diabetes: Type 1 and Type 2 Diabetes: Assessment, Analysis, and Associated Dental Management Guidelines

Absence of insulin causes elevated glucagons levels, muscle wasting, and high levels of acetoacetic acid and hydroxybuteric acid in the blood.

Excessive glucose (hyperglycemia) in the blood causes it to spill into the urine resulting in glycosuria and frequent urination.

Type 1 Diabetes

The exact etiology of type 1 diabetes is not known. Autoimmune attack on the β cellsof the pancreas is thought to cause destruction of the cells and consequent lack of insulinproduction. An environmental stimulus, however, is not discounted. The patients areusually younger, thin, and prone to ketosis, weight loss, and blackouts.

Type 2 Diabetes

These patients have a combination of insulin resistance and insulin defi ciency. 90% ofdiabetics encountered suffer from type 2 diabetes. Type 2 diabetes has a higher geneticpredisposition compared to type 1 diabetes.The patients are usually obese and older at the time of disease onset.

Diabetes Symptoms and Signs

Polyuria (excessive urination)polydipsia (excessive thirst)polyphagia (excessive appetite)

type 1 diabetes experience these symptoms a lot more frequently compared to the type 2 diabetic patient.

experience weight loss, fatigue, and blurred vision due to the elevated blood sugar levels.

A weight loss history is a lot more common in the type 1 patient compared to the type 2 diabetic.

Poor wound healing and opportunistic infections occur with chronic elevation of the blood sugar values.

Diabetes Diagnostic Tests

Fasting Blood Sugar (FBS)

fasting blood sugar (FBS) is ≥126 mg/dL. With treatment, the FBS should be maintained between 70–100 mg/dL.FBS should be maintained above 60–70 mg/dL to avoid precipitation hypoglycemia.

Impaired FBS

.prediabetes or impaired fasting glucose when the FBS is 100– 125 mg/dLاعراض بدائية

normalize the impaired FBS sugar levels with stringent implementation of proper diet control and exercise.

Postprandial Blood Sugar (PPBS) الطعام بعد2-hr postmeal blood sugar should be maintained between 100–140 mg/dL.

Oral Glucose Tolerance Test (OGTT)

FBS is checked and the patient is made to drink 75–100 g of glucose. The bloodsugar levels are then monitored at half-hour intervals for 2 hr. The patient is said to beprediabetic if the blood sugar at 2 hr ranges between 140–200 mg/dL. Values 200 mg/dLindicate diabetes defi nitely.

HemoglobinA 1C (HbA1C)

The normal reference range of HbA1C is: 4–5.9%. Hemoglobin A in the RBCs combineswith glucose, forming a glycated hemoglobin molecule, HbA1C.

HbA1C increases as the blood glucose concentration increases.

ACUTE MEDICAL EMERGENCIES ASSOCIATED WITH DIABETES

Hypoglycemia

Acute hypoglycemia reaction can occur in both the diabetic and the nondiabetic patient.

The brain can sustain itself only for less than 3 min when the patient collapses because of hypoglycemia.

the treatment has to be immediate to avoid brain damage or other negative consequences.

Hyperglycemia

Diabetic ketoacidosis (DKA) and coma can occur because of infection, poor intake ofmedications.

The patient must be sent to the emergency room where treatment is provided with fluids and Insulin.

CHRONIC MEDICAL COMPLICATIONS OF DIABETES

Microvascular Disease: Retinopathy and Nephropathy

Retinopathy is the leading cause of blindness and should be differentiated from theblurring of vision caused by excessive sugar getting attached to the lens in the eyes.

Diabetes accounts for 25% of all kidney failure and diabetes is the leading cause for dialysis.

Macrovascular Disease

increased incidence of CVA/stroke and myocardial infarction (MI) that is often silent because of underlying autonomic neuropathy.

affects the peripheral circulation causing peripheral vascular disease and narrowing of the blood vessels, and this can lead to amputation of the limbs.

Neuropathy

Autonomic neuropathy causes gastroparesis, which is associated with a slowing down of the stomach.The patient feels full after a few bites and experiences gastric refl ux, halitosis, and vomiting.

This patient therefore will do better when given shorter dental appointments and treatment is provided in a semisitting position.

Skin or Mucus Membrane Infections

Yeast infections affect the oral cavity , oral candidiasis and/or esophageal candidiasis.

ask the patient about dysphagia (diffi culty swallowing) or odynophagia (painful swallowing) whenever you see oral candidiasis and/or elevated blood sugar values.

Urinary tract infection is another complication of hyperglycemia and it affects the female diabetic patient more commonly.

Staphylococcal infections of the hair follicles cause chronic skin problems in the uncontrolled diabetic.

DIABETES MANAGEMENT

Type 1 Diabetes

daily insulin by subcutaneous (SC) injections or via an insulin pump.

Type 2 Diabetes

diet, exercise, oral antidiabetic medications, insulin, or a combination of oral agents and insulin.

Diabetes Medical Management

DIABETES DENTAL ALERTS AND SUGGESTED MANAGEMENT GUIDELINES FOR DENTISTRY