Diabetes

Chapter 49: Diabetes

Learning Objectives

  • Lesson 49.1: Diabetes

    1. Differentiate between:
    • Prediabetes
    • Type 1 diabetes
    • Type 2 diabetes
    • Gestational diabetes

    Aspects to cover:

    • Prevalence
    • Characteristics
    • Pathophysiology
    • Potential complications
    1. Discuss the two-way relationship between diabetes and periodontal disease.
    • Provide client education on:
      • Self-monitoring
      • Lifestyle changes
      • Pharmacological therapy
    • Engage patients with diabetes as co-therapists in management of both diabetes and oral care.
    1. Plan dental hygiene care for a person with diabetes and periodontal disease:
    • Collaborate interprofessionally with the patient’s primary healthcare provider.

    1. Recognize a diabetic emergency and take appropriate action for management.

    2. Provide client education regarding lifestyle adjustments and oral self-care to engage patients or community groups with diabetes as co-therapists in management of both diseases.

    3. Assist patients at risk for diabetes in prevention strategies.

Epidemiology of Diabetes

  • Statistics:
    • Affects approximately 37.3 million adults and children in the U.S.
    • Represents about 11.3% of the population.
    • More than 8.5 million are unaware of their diabetes.
    • Estimates indicate at least one in three people will develop diabetes in their lifetime.

Definition and Pathophysiology of Diabetes

  • Diabetes:
    • A group of disorders characterized by hyperglycemia (high blood glucose) due to defects in insulin production, insulin function, or both.
    • Chronic hyperglycemia can damage nerves (neuropathy), eyes, kidneys, heart, and blood vessels (microangiopathy).
Prediabetes
  • Impaired Glucose Tolerance and Impaired Fasting Glucose:
    • Condition preceding type 2 diabetes marked by blood glucose levels higher than normal but below diagnostic levels.
    • Approximately 38% of the U.S. adult population has diagnosed prediabetes.
    • High risk for developing diabetes and cardiovascular disease.
    • Associated with:
    • Abdominal obesity
    • High triglyceride levels
    • Low high-density lipoprotein (HDL) levels
    • Hypertension
    • Symptoms: No symptoms present.

Classification of Diabetes

Type 1 Diabetes
  • Characteristics:
    • High blood glucose levels primarily due to a total lack of insulin.
    • Represents 5% of the adult diabetic population.
    • Commonly presents in childhood/adolescence but can occur at any age.
    • Rarely obese due to diabetic ketoacidosis.
    • Requires regular lifelong administration of insulin via injection or pump.
    • Results from the immune system attacking insulin-producing beta cells in the pancreas.
    • Genetic and environmental factors contribute.
Type 2 Diabetes
  • Characteristics:
    • Most common form: approximately 90-95% of diabetic population.
    • Caused by insulin deficiency and/or the body's inability to use insulin efficiently.
    • Preventable condition.
    • Risks:
    • Increases with obesity, age, sedentary lifestyle, gestational diabetes history, hypertension, and dyslipidemia.
    • Gradual onset: often undiagnosed for years (up to 10 years).
    • Often responds positively to:
    • Weight reduction
    • Dietary management
    • Exercise
    • Oral hypoglycemic medications
    • Predominantly genetically inherited.
Gestational Diabetes Mellitus (GDM)
  • Affects 7.8% of pregnancies in the United States.
  • High-risk indicators include:
    • Marked obesity
    • Previous GDM
    • Strong family history of diabetes
    • Glucosuria (glucose in urine)
  • GDM usually reverts post-birth.
  • Associated with increased risk of perinatal morbidity and mortality.

Diagnostic Tests

  1. A1C Test (HbA1c):

    • Measures average blood sugar levels over the past 2-3 months.
    • Indicates how much sugar is attached to hemoglobin in red blood cells.

  2. **FPG (Fasting