Crash review about diabetes mellitus types ,sign and symptoms, oral complication ,and its dental management in what so called medically compromised patient .

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diabetes
mellitus
By: Mohammed Al-Shalfi

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What is diabetes mellitus ?
In General : Diabetes mellitus refers to a group of metabolic diseases that affect how the
body uses blood sugar (glucose).

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• Diabetes Type 1 : Beta cells of the pancreas is not producing enough insulin.
• Common complication = ketoacidosis that leads to coma
What are the types of DM ?
• Diabetes type 2 : the cells of the body are not responding properly to the
insulin produced
• Common complication = hypoglycemia
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● Prediabetes: This type is the stage before Type 2 diabetes. Your blood
glucose levels are higher than normal but not high enough to be officially
diagnosed with Type 2 diabetes.
What are the types of DM ?
• Gestational diabetes: This type develops in some women during
their pregnancy. Gestational diabetes usually goes away after
pregnancy. However, if you have gestational diabetes you're at higher
risk of developing Type 2 diabetes later on in life.
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Less common types of diabetes include:
● Monogenic diabetes syndromes: These are rare inherited forms of
diabetes accounting for up to 4% of all cases. Examples are neonatal
diabetes and maturity-onset diabetes of the young.
● Cystic fibrosis-related diabetes: This is a form of diabetes specific to
people with this disease.
● Drug or chemical-induced diabetes: Examples of this type happen after
organ transplant, following HIV/AIDS treatment or are associated with
glucocorticoid steroid use.
● Diabetes insipidusis a distinct rare condition
that causes your kidneys to produce a large amount of urine.
What are the types of DM ?

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Signs and
symptomes :
• Polyuria, (especially nocturia)
• Polyphagia
• Polydipsia + Dry lips
• Rapid and unexplained body weight loss
• Blurred vision

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Signs and
symptomes :
• Oral complications of poorly
controlled DM :
1- Xerostomia [ caused by the polyuria] + increased
incidence and severity of caries
2- Bacterial, viral, and fungal infections (including
candidiasis)
3- poor wound healing
4- gingivitis and periodontal disease
5- burning mouth symptoms

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Diagnosis of diabetes:
A t l e a s t o n e o f t h e f o l l o w i n g :
1- A fasting (> 8-hour) plasma glucose of > 126 mg/dL on two separate
occasions [ex; measured on a Sunday then measured on a Tuesday]
2- A random plasma glucose of > 200 mg/dL plus symptoms.
3- A two-hour postprandial glucose of > 200 mg/dL after a glucose
tolerance test on two separate occasions.
• NORMAL GLUCOSE RANGE = 80 -120 mg/dl

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Did you know?
• Insulin is important because it will allow glucose to be absorbed into the
cells of muscles and other tissues , when insulin is absent or very low
[ undiagnosed or uncontrolled diabetic ] the body cannot absorb the
glucose → starts breaking down fat for energy → build up of acids in the
blood stream [ketones] → ketoacidosis and fruity smell of the breath .

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Controlled diabetic = did not change
their medication dose or blood sugar
reading for the past 3 months
― Irene M. Pepperberg

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Q: what should you ask every diabetic patient ?
1- How much insulin they use, what type & how often they
inject themselves each day
2- Whether their diabetes is well-controlled (if so they are
more likely to go hypo)
3- What their signs/symptoms of a hypo are (these should be
updated regularly)
4- What their HbA1c is
Your goal as a dentist is to prevent insulin
shock during the dental appointment

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Diabetic patient Management :
Brittle diabetes [ mostly in type 1] = pt flips between
hypo and hyper quickly. Pts being treated with
large doses of insulin have periods of extreme
hyperglycemia & hypoglycemia. – such pts are at
higher risk for infection.
You can only give emergency tx to a pt with brittle
diabetes + Close consultation with the physician is
required before any dental treatment .

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Diabetic patient Management :
• If diabetes is well-controlled → all dental
procedures can be performed without
special precautions.
If not well-controlled [can be hyper >200
mg/dl or hypo <70 mg/dl ]→ emergency only

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Diabetes patient in General
1- Give morning appointments.
2- usual insulin dosage and normal meals on day of dental appointment.
3- patient should inform dentist if symptoms of insulin reaction occur during dental visit.
4- Glucose source (orange juice, soda, Glucola) should be available and given to patient if
symptoms of insulin reaction.

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Anesthesia Consideration in DM
Epinephrine has an opposite effect to insulin, so blood
glucose could rise with the use of epinephrine
→ In diabetic pts, Use Mepivacaine
Advantage of mepivacaine: no toxicity/ allergy , no BP
elevation.
Disadvantages of mepivacaine : short acting + risk of
bleeding.
• In long procedures → give one lidocaine then continue
with mepivacaine
Q: why should you test blood sugar before giving IAN
block? Because tingling in lips is sign of ‘hypo’
and it could be mistaken as the normal sign of LA.

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