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Chapter 6
Diabetes
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History
• Diabetes mellitus: a disease of metabolism
that occurs as a result of either a
deficiency or a complete lack of insulin in
the body
• Early 1920s: lack of insulin discovered to
be the cause of diabetes
– Animal insulin used as treatment
• 1980s: bioengineered insulin as treatment
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2
Functions of Glucose and
Insulin
• Glucose: fuel for the body from the food
we eat
– Body has to have glucose to survive
• Insulin: a hormone produced by the
pancreas
– Insulin must be present for glucose to enter
cells
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copied, duplicated, or posted to a publicly accessible website, in whole or in part.
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Functions of Glucose and
Insulin
• Patients with diabetes who have to take
insulin:
– Pancreas is usually not producing insulin or
not producing enough insulin
• Patients with diabetes who do not have to
take insulin:
– Pancreas usually produces enough or too
much insulin
– Problem is the insulin receptors
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Functions of Glucose and
Insulin
• Important that levels of glucose in the
blood be kept at appropriate levels
– Glucose can be toxic to other tissues
– Too much glucose can be as problematic as
too little
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5
Type I and Type II Diabetes
• Type I—Insulin Dependent Diabetes
Mellitus (IDDM)
– Seen most often in the young
• May be known as juvenile diabetes
– Associated most often with additional medical
problems
– Requires daily insulin injections
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6
Type I and Type II Diabetes
• Type II—Noninsulin Dependent Diabetes
Mellitus (NIDDM)
– Occurs most often in obese adults
– Usually controlled with diet and/or oral
hypoglycemic
– Is increasing in younger patients due to the
increased obesity levels
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Type I and Type II Diabetes
• Complications of diabetes can include:
– Macrovascular disease
– Microvascular disease
– Neuropathy
• Imbalance of glucose can result in the
following conditions:
– Hypoglycemia
– Hyperglycemia
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Causes of Diabetes
• Most causes are unknown
• Theory as to what causes diabetes:
– Heredity
– Type I diabetes may be caused by a virus
related to the mumps that damages cells of
the pancreas
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Causes of Diabetes
– Type II diabetes can be caused by pregnancy,
which results in drastic hormonal changes in
the body
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Classification
• Classified as Type I or Type II
• Type I used to be called juvenile diabetes
– Also occurs in older people
– Type I diabetes is insulin-dependent diabetes
– Body does not produce enough insulin
– Person must inject insulin or it must be
delivered via pump
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Classification
– Majority of medical problems occur with Type I
because patient has the disease for so long
• Type II diabetes used to be called adult
onset
– Changed the name because the condition
also occurs in the young
– Most people with Type II diabetes are middleaged and obese
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Classification
– Accounts for majority of cases of diabetes
– Usually controlled with diet, exercise, and oral
hypoglycemics
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Gestational Diabetes
• Forms in pregnancy, ends after delivery
• Pregnancy hormones block insulin
– Most women produce enough additional
insulin to overcome the blocking effect
– When the pancreas produces all the insulin it
can and there is still not enough, diabetes
develops
– When the placenta’s hormones are removed
after delivery, diabetes ends
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Gestational Diabetes
• Some women are at greater risk:
– Obese
– Family history of diabetes
– Having given birth previously to a very large
infant
– Stillbirth, or a child with a birth defect
– Having too much amniotic fluid
– Older than 25
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Oral Hypoglycemics
• Medications that lower blood sugar
• Not effective for Type I diabetes
• Best to first try to treat with diet and
exercise
• Not used with pregnant patients or
patients with kidney or liver problems
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Diabetic Emergencies:
Hyperglycemia and Hypoglycemia
• Hyperglycemia: too much blood glucose
• Hypoglycemia: too little blood glucose
• Both of these can develop into an
emergency situation
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Hyperglycemia
• Occurs when there is too much glucose
(sugar) in the blood
– Usually seen when there is a deficiency or
lack of insulin
– Slow occurring condition
– Patient exhibits increased urination and thirst
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Hyperglycemia
– May also exhibit loss of appetite, nausea
and/or vomiting, fatigue, abdominal pains, and
generalized aches
• If condition is allowed to progress, patient
will exhibit Kussmaul breathing (heavy,
labored breathing)
– Patient’s breath will have a fruity, acetone
odor
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Hyperglycemia
• Without treatment, patient could lose
consciousness and die
– Diabetic coma: now rare as symptoms are
identifiable for several days prior
• People experiencing hyperglycemia
require insulin injections
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Hyperglycemia
• If unconscious, patient should be
transported to a medical facility by medical
transport
• Dental staff should not inject insulin into an
unconscious patient as the amount
needed is unknown
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Hypoglycemia
• Also known as insulin shock
• Occurs as a result of too little glucose in
the body
• Usually has rapid onset and caused by:
– Skipping a meal
• Ask patient when they last ate a meal
– Unusual amount of exercise
– Change in routine
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Hypoglycemia
• Person may exhibit:
– Cold sweat and appear nervous, trembling,
weak, hungry
– Personality change, including irritability,
confusion, and the inability to think clearly
• Patient may appear upset and refuse
treatment
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Hypoglycemia
• Patient requires treatment as soon as
possible:
– Some type of sugar into the patient
• Orange juice
– If the patient is unconscious
• Administer glucagon by injection
– A hormone produced by the pancreas to increase blood
sugar
• Once patient regains consciousness, orange juice
should be administered
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Diabetic Coma or Insulin
Shock?
• If the type of diabetes is unknown, treat
the condition as insulin shock
– Administer glucagon
– Brain damage can occur quickly without
glucose
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Diabetic Coma or Insulin
Shock?
– Body can handle large amounts of glucose
longer than the brain can survive with low
levels of glucose
– If recovery does not occur, call EMS
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Medical Problems
• Diabetes increases macrovascular (largevessel) abnormalities via inadequate blood
supply to the:
– Heart (myocardial infarction, angina pectoris)
– Brain (cerebrovascular accidents)
– Legs (infection or tissue necrosis)
– Kidneys (dysfunction or failure)
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Medical Problems
• Diabetes increases microvascular (smallvessel) abnormalities via inadequate blood
supply to the:
– Eyes
• Diabetic retinopathy can cause
blindness
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Oral Manifestations
• Patient may experience diabetic coma or
insulin shock in the dental office
• Dental team may have to alter treatment to
avoid a medical emergency
• Severe periodontal disease is common
among diabetic patients
– Even with good oral hygiene habits
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Oral Manifestations
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Oral Manifestations
Other oral diseases associated with diabetes include:
• Xerostomia
• Abnormal taste
• Prolonged or recurrent fungal or bacterial infections
• Burning mouth syndrome - painful, frustrating
condition often described as a scalding sensation in
the tongue, lips, palate, or throughout the mouth.
• Dental caries
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Oral Manifestations
– Consult the patient’s physician for any
extensive treatment
– Keep the patient calm during procedures
– Avoid scheduling appointments during typical
mealtimes
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Oral Manifestations
• Team should understand how to work with
patients of different ages with diabetes
– Children with diabetes may be concerned
about new situations such as a dental
appointment
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Oral Manifestations
– Adolescents may not be monitoring their
blood sugar and controlling their diabetes
• Could experience a reaction during dental
treatment
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Summary
• Diabetes has only been studied and
effectively treated for about 60 years
• Remarkable advancements have occurred
rapidly
• It is hoped that further advancements will
alleviate potential diabetic emergencies in
the dental office, such as diabetic coma
and insulin shock
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copied, duplicated, or posted to a publicly accessible website, in whole or in part.
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