DIABETES MELLITUS - DH 24 - Mrs.Kunz
Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia (abnormally increased blood glucose) resulting from defective insulin secretion or defective insulin action or a combination of both.
Insulin is an anabolic hormone that stimulates the entry of glucose into the cell to enhance fat storage. Without it, glucose stays in the bloodstream instead of being stored or used by other cells to produce energy.
Normal blood glucose level: 80-120mg/dl
There are 3 types of DM. Type 1 Diabetes Mellitus (Insulin Deficient)-DM1: 5-10% of Diabetic population has DM1. On set occurs during childhood or adolescence. The disease process precedes symptoms by several years, the clinical presentation usually includes: sudden polydipsia ( increased thirst), polyuria ( increased urination), unexplained weight loss, dehydration, & fatigue. Other symptoms include; sudden vision changes, polyphagia (increased appetite), tingling or numbness in the hands or feet, dry skin, recurrent infections, & slow wound healing. If diabetic ketoacidosis (DKA) is present, symptoms may include abdominal pain, nausea, vomiting, hyperventilation, fruity breath odor, & altered level of consciousness. Risk factors for DM1 include certain human leukocyte antigen (HLA) type (i.e., HLA-DR, HLA-DQ), the presence of a specific protein that may be responsible for antibody formation, & DM1 in first degree of greater risk if it’s present in the male parent. Viral infections, mumps, congenital rubella, & coxsackievirus, that trigger an autoimmune response that results in the destruction of pancreatic b-cells are also a risk factor of DM1(Strayer & Schub,2010) . Type 2 Diabetes Mellitus (Insulin Resistant)-DM2: 90-95% of Diabetic population has DM2. Onset: Usually occurs for people over 40 year old. Family history, previous gestational diabetes (onset during pregnancy), previous abnormalties in fasting blood glucose or glucose tolerance, obesity, sedentary lifestyle, increased age, hypertension, polycystic ovarian syndrome, & dyslipidemia are risk factors of DM2. Approximately 80% of patients with DM2 are obese. Most commonly complain of symptoms are fatigue, recurrent infections, prolonged wound healing, & vision changes. Presentation classic symptoms are polyuria (increased urination), polydipsia (increased thirst), unexplained changes in weight, & polyphagia (increased appetite). Macro- and microvascular complications are renal dysfunction, eye disease, atherosclerotic cardiovascular & periphenal vascular disease, periphenal neuropathy, & infection or gangrene of the extremities(Stray & Schub 2011). Gestational Diabetes Mellitus (GDM): 4% of pregnancies in U.S. Obesity, previous gestational diabetes, strong family history of diabetes, glucosuria (glucose in the urine) are risk factors of GDM. There are NO symptoms, you must be tested for the condition. Testing is done between 24-28 weeks of pregnancy.
The relationship between diabetes mellitus (DM) and periodontal disease has been the subject of many studies that underline that diabetic patients are two or three times more susceptible to having an increased risk of periodontal disease, especially when metabolic control is inadequate. Recent studies have showed how hygiene and professional control could support a reduction of the glycate hemoglobin and, therefore, of periodontal disease. Preliminary results have shown a reduction of HbAic in diabetic patients subjected to a periodontal treatment with mouthwash. The relationships between DM and age also have been noticed in periodontal destruction. The medical control, using systemic antibiotics, is important in diabetic patients, showing loss of bone or of periodontal attack, with high level of calculus.
Phorphiromonas gingivallis-Pg (associated with low levels of “supra-gingival” plaque), Tennarela forsythensis-Tf (together with Pg, associated with high levels of plaque with risk of loss of attack), Actinobacillus actnomycetemcomitans-Aa (in association with Pg, causes serious periodontal destructions). 70/80% of DM2 patients showed as the most frequent bacteria species: Prevotella intermedia, Campylobacter rectus, Porphiromonas gingivalis. In DM1 patients, porphiromonas gingivalis and P. intermedia play a major role in the invasion of the oral epithelium.
Porphiromonas gingivalis and Tannerela forsythia could play a major role in the virulence and progression of periodontal disease, promoting adhesion and the invasion of tissues with the beginning of infections and chronic periodontitis.
Periodontium is highly susceptible to the pathogenic activity of the collagenases, of the metallo-proteases (MMP), of the collagen reduction and of the glycosaminoglycans synthesis. The periodontal disorders frequently lead to other complications in increasing of diabetic nephropathy and cardiovascular disturbances in DM1, affected by heavy periodontal disorders. Periodontopatic diabetic or non-diabetic patients showed higher vascular endothelium growing factor (FEGF) concentrations and a major micro-vascular density in type 1 compared to healthy and type 2 diabetic individuals (Marigo et al, 2011).
After reading all of these research articles, I have become more knowledgeable about DM. I have learned how to communicate with my patients about the disease and how to manage the disease. If the patients were at high risk for DM, I would encourage them to ask their primary clinician for a reference to a diabetes specialist. I will educate patients about the relationship between periodontitis and DM including how healthy dietary habits, and physical activities can reduce the risk of DM and periodontitis. It has shown me how to assess my patient's health history and ask any necessary questions to identify the patient's risk of diabetes. It has also shown me the special modifications that I need to use for patients with diabetes such as brief morning appointments to minimize stress & anxiety & avoid interference with eating & medication schedules, put patients in supine position during the appoiments, use safety precautions. In addition, I can give diabetic patients their OHI/home care instructions with using fluoride toothpaste or gel prescribed by dentist, do not use mouthwash if oral lesions are present, use Biotene when Xerostomia present, brushing teeth after meal when Periodontitis or Gingivitis are present.
PERSONAL REFLECTION: I chose Diabetes Mellitus because of its high incidence. About 26 million Americans have diabetes, another 79 million people in the United States have prediabetes (Strayer, Schub 2011). I wanted to learn about it so I can take care of my patients, my family, and myself.
During lectures in class, I discovered that diabetes was linked to periodontal disease. This interested me in Diabetes Mellitus.
REFERENCES:
Marigo, L., Cerreto, R., Giuliani, M., Somma, F., Lajolo, C., & Cordaro, M. (2011)
Diabetes Mellitus: biochemical, histological and microbiological aspects in periodontal disease.
European Review for Medical and Pharmacological Sciences, 15: 751-758.
Strayer, D. & Schub, T. (2010)
Diabetes Mellitus, Type 1 -quick Lesson
GDM articles on EBSCO, Cinahl Information Systems
Strayer, D. & Schub, T. (2011)
Diabetes Mellitus, Type 2 -quick Lesson
GDM articles on EBSCO, Cinahl Information Systems
ADDITIONAL INFORMATION: The Juvenile Diabetes Research Foundation International, http://www.jdrf.org/
The American Diabetes Association, http://www.diabetes.org/
Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia (abnormally increased blood glucose) resulting from defective insulin secretion or defective insulin action or a combination of both.
Insulin is an anabolic hormone that stimulates the entry of glucose into the cell to enhance fat storage. Without it, glucose stays in the bloodstream instead of being stored or used by other cells to produce energy.
Normal blood glucose level: 80-120mg/dl
There are 3 types of DM. Type 1 Diabetes Mellitus (Insulin Deficient)-DM1: 5-10% of Diabetic population has DM1. On set occurs during childhood or adolescence. The disease process precedes symptoms by several years, the clinical presentation usually includes: sudden polydipsia ( increased thirst), polyuria ( increased urination), unexplained weight loss, dehydration, & fatigue. Other symptoms include; sudden vision changes, polyphagia (increased appetite), tingling or numbness in the hands or feet, dry skin, recurrent infections, & slow wound healing. If diabetic ketoacidosis (DKA) is present, symptoms may include abdominal pain, nausea, vomiting, hyperventilation, fruity breath odor, & altered level of consciousness. Risk factors for DM1 include certain human leukocyte antigen (HLA) type (i.e., HLA-DR, HLA-DQ), the presence of a specific protein that may be responsible for antibody formation, & DM1 in first degree of greater risk if it’s present in the male parent. Viral infections, mumps, congenital rubella, & coxsackievirus, that trigger an autoimmune response that results in the destruction of pancreatic b-cells are also a risk factor of DM1(Strayer & Schub,2010) . Type 2 Diabetes Mellitus (Insulin Resistant)-DM2: 90-95% of Diabetic population has DM2. Onset: Usually occurs for people over 40 year old. Family history, previous gestational diabetes (onset during pregnancy), previous abnormalties in fasting blood glucose or glucose tolerance, obesity, sedentary lifestyle, increased age, hypertension, polycystic ovarian syndrome, & dyslipidemia are risk factors of DM2. Approximately 80% of patients with DM2 are obese. Most commonly complain of symptoms are fatigue, recurrent infections, prolonged wound healing, & vision changes. Presentation classic symptoms are polyuria (increased urination), polydipsia (increased thirst), unexplained changes in weight, & polyphagia (increased appetite). Macro- and microvascular complications are renal dysfunction, eye disease, atherosclerotic cardiovascular & periphenal vascular disease, periphenal neuropathy, & infection or gangrene of the extremities(Stray & Schub 2011). Gestational Diabetes Mellitus (GDM): 4% of pregnancies in U.S. Obesity, previous gestational diabetes, strong family history of diabetes, glucosuria (glucose in the urine) are risk factors of GDM. There are NO symptoms, you must be tested for the condition. Testing is done between 24-28 weeks of pregnancy.
The relationship between diabetes mellitus (DM) and periodontal disease has been the subject of many studies that underline that diabetic patients are two or three times more susceptible to having an increased risk of periodontal disease, especially when metabolic control is inadequate. Recent studies have showed how hygiene and professional control could support a reduction of the glycate hemoglobin and, therefore, of periodontal disease. Preliminary results have shown a reduction of HbAic in diabetic patients subjected to a periodontal treatment with mouthwash. The relationships between DM and age also have been noticed in periodontal destruction. The medical control, using systemic antibiotics, is important in diabetic patients, showing loss of bone or of periodontal attack, with high level of calculus.
Phorphiromonas gingivallis-Pg (associated with low levels of “supra-gingival” plaque), Tennarela forsythensis-Tf (together with Pg, associated with high levels of plaque with risk of loss of attack), Actinobacillus actnomycetemcomitans-Aa (in association with Pg, causes serious periodontal destructions). 70/80% of DM2 patients showed as the most frequent bacteria species: Prevotella intermedia, Campylobacter rectus, Porphiromonas gingivalis. In DM1 patients, porphiromonas gingivalis and P. intermedia play a major role in the invasion of the oral epithelium.
Porphiromonas gingivalis and Tannerela forsythia could play a major role in the virulence and progression of periodontal disease, promoting adhesion and the invasion of tissues with the beginning of infections and chronic periodontitis.
Periodontium is highly susceptible to the pathogenic activity of the collagenases, of the metallo-proteases (MMP), of the collagen reduction and of the glycosaminoglycans synthesis. The periodontal disorders frequently lead to other complications in increasing of diabetic nephropathy and cardiovascular disturbances in DM1, affected by heavy periodontal disorders. Periodontopatic diabetic or non-diabetic patients showed higher vascular endothelium growing factor (FEGF) concentrations and a major micro-vascular density in type 1 compared to healthy and type 2 diabetic individuals (Marigo et al, 2011).
After reading all of these research articles, I have become more knowledgeable about DM. I have learned how to communicate with my patients about the disease and how to manage the disease. If the patients were at high risk for DM, I would encourage them to ask their primary clinician for a reference to a diabetes specialist. I will educate patients about the relationship between periodontitis and DM including how healthy dietary habits, and physical activities can reduce the risk of DM and periodontitis. It has shown me how to assess my patient's health history and ask any necessary questions to identify the patient's risk of diabetes. It has also shown me the special modifications that I need to use for patients with diabetes such as brief morning appointments to minimize stress & anxiety & avoid interference with eating & medication schedules, put patients in supine position during the appoiments, use safety precautions. In addition, I can give diabetic patients their OHI/home care instructions with using fluoride toothpaste or gel prescribed by dentist, do not use mouthwash if oral lesions are present, use Biotene when Xerostomia present, brushing teeth after meal when Periodontitis or Gingivitis are present.
PERSONAL REFLECTION: I chose Diabetes Mellitus because of its high incidence. About 26 million Americans have diabetes, another 79 million people in the United States have prediabetes (Strayer, Schub 2011). I wanted to learn about it so I can take care of my patients, my family, and myself.
During lectures in class, I discovered that diabetes was linked to periodontal disease. This interested me in Diabetes Mellitus.
REFERENCES:
Marigo, L., Cerreto, R., Giuliani, M., Somma, F., Lajolo, C., & Cordaro, M. (2011)
Diabetes Mellitus: biochemical, histological and microbiological aspects in periodontal disease.
European Review for Medical and Pharmacological Sciences, 15: 751-758.
Strayer, D. & Schub, T. (2010)
Diabetes Mellitus, Type 1 -quick Lesson
GDM articles on EBSCO, Cinahl Information Systems
Strayer, D. & Schub, T. (2011)
Diabetes Mellitus, Type 2 -quick Lesson
GDM articles on EBSCO, Cinahl Information Systems
ADDITIONAL INFORMATION: The Juvenile Diabetes Research Foundation International, http://www.jdrf.org/
The American Diabetes Association, http://www.diabetes.org/