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 cells
of the pancreas is thought to cause destruction of the cells and consequent lack of insulin
production. An environmental stimulus, however, is not discounted. The patients are
usually 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% of
diabetics encountered suffer from type 2 diabetes. Type 2 diabetes has a higher genetic
predisposition 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 70100 mg/dL.
FBS should be maintained above 6070 mg/dL to avoid precipitation hypoglycemia.

Impaired FBS
prediabetes or impaired fasting glucose when the FBS is 100 125 mg/dL.

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

Postprandial Blood Sugar (PPBS)
2-hr postmeal blood sugar should be maintained between 100140 mg/dL.

Oral Glucose Tolerance Test (OGTT)
FBS is checked and the patient is made to drink 75100 g of glucose. The blood
sugar levels are then monitored at half-hour intervals for 2 hr. The patient is said to be
prediabetic if the blood sugar at 2 hr ranges between 140200 mg/dL. Values 200 mg/dL
indicate diabetes defi nitely.

HemoglobinA1C (HbA1C)
The normal reference range of HbA1C is: 45.9%. Hemoglobin A in the RBCs combines
with 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 of
medications.

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 the
blurring 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