Chapter 54: The Patient with Diabetes Mellitus

Learning Objectives

• Understand the definition and types of Diabetes Mellitus.
• Recognize the complications and prevalence of diabetes.
• Learn about oral health implications and risk factors related to diabetes.
• Know the impact of diabetes on various ethnic groups and age factors.

Definition of Diabetes Mellitus

• Diabetes Mellitus: Group of metabolic diseases characterized by hyperglycemia (high blood glucose).
  • Causes: Insulin deficiency, resistance to insulin action, or both.

Complications of Poorly Controlled Diabetes

• Retinopathy: Loss of vision.
• Kidney Failure.
• Cardiovascular Diseases: Includes atherosclerotic and cerebrovascular diseases.
• Peripheral Neuropathy: Nerve damage, often leading to amputations.

Pre-Diabetes and Prevalence

• Pre-Diabetes: Affects 1 in 3 people; prevalent in those aged 65+.
• Similar prevalence across racial and ethnic groups.
• Higher prevalence of full-blown diabetes in American Indians, Alaskan Natives, Non-Hispanic Blacks, and Hispanics.

Oral Health Implications

• Poor healing response to infections.
• Signs of undiagnosed diabetes include delayed healing and increased risk for periodontitis.

Insulin

• Insulin: A hormone produced by beta cells in the pancreas.
  • Type 1 Diabetes: Beta cells are destroyed; lack insulin production.
  • Type 2 Diabetes: Insufficient insulin secretion; cells resist insulin.

Symptoms and Diagnosis

• Three P's: Polyuria (frequent urination), Polydipsia (excessive thirst), Polyphagia (increased hunger).
• Diagnosis: A1C testing, fasting glucose levels, and oral glucose tolerance tests.

Diabetes Risk Factors

• Overweight (BMI > 25), physical inactivity, family history.
• High-risk ethnic groups, history of gestational diabetes.

Types of Diabetes

• Type 1: 5-10% of cases, autoimmune, insulin-dependent.
• Type 2: 90-95% of cases, often adult onset but increasing in youth.
• Gestational Diabetes: Occurs during pregnancy, risk for later type 2 diabetes.

Insulin Administration and Therapy

• Methods: Pumps, injections, pens, inhalation.
• Anti-hyperglycemic medications such as Metformin.
• Importance of lifestyle management for control.

Complications of Diabetes

• Infections, Neuropathy, Nephropathy, Retinopathy.
• Increased risk for periodontal disease and tooth mobility.

Dental Care Considerations

• Regular Appointments: Check for signs of diabetes complications.
• Medical History Review: Ensure up-to-date information.
• Patient Education: Importance of oral hygiene and regular care.

Management and Education

• Encourage regular medical and dental check-ups.
• Educate on oral health and diabetes connection.
• Support lifestyle changes for better diabetes management.

Conclusion

• Understanding diabetes is crucial for managing oral health in diabetic patients.
• Dental professionals play a role in early detection and patient education.