What it is and its Dental Management
A person who has diabetes have a high blood glucose level (hyperglycemia) and inability for the body to produce insulin. Diabetes is a chronic or a long term condition. In the long run, this causes metabolic and vascular complications that include premature macrovascular disease and serious microvascular diseases.
When blood sugar is elevated, there is a change in lipid-protein metabolism and then results in lack of insulin. When blood sugar is well-maintained, this slows down the process of complications in our blood vessels. This can show in the blood vessels as atherosclerosis, eye and kidney microangiopathy. Retinopathy and nephropathy are end complications of diabetes.
To understand the pathophysiology and complications of diabetes, this is how it goes:
- The sugar in our blood is taken up by the pancreas and becomes a stimulus for insulin secretion.
- Insulin does not stay for long periods of time because it interacts with target tissues like muscles, liver, fat cells.
- The process pushes on forward into the intracellular system and makes way for enzymatic and glucose transport.
- If the insulin is lacking, then there is abnormal production of carbohydrates, fat and protein.
- When there is abnormality in production and utilization of glucose, it gets stuck in tissues and blood.
- This results in hyperglycemia and then the sugar can be excreted in the urine. With this, there could also be loss in fluid and then lead to dehydration and loss of electrolytes.
- If the cells of the body do not metabolize glucose properly and this progresses, then it continues to develop acidosis.
- The respiratory and renal system may not be able to compensate and therefore body fluids become acidic.
- All manifestations of diabetes- hyperglycemia, ketoacidosis, and vascular wall disease- all of them contribute to poor wound healingand decreased ability to fight off infections.
Severe acidosis lead to coma. Some microvascular and atherosclerotic complications can be related to the level of hyperglycemia. Retinopathy is another concern for these patients but one of the more serious conditions the diabetics are likely to acquire is ESRD or end stage renal disease. This then further decreases the tendency for healing and fighting off infections.
As mentioned earlier, the condition that develops is atherosclerosis and this further increases the risk for ulceration and gangrene of feet, hypertension, renal failure, coronary insufficiency, myocardial infarction and stroke.
In relation to this other complication which is neuropathy, this could also be manifested as muscle weakness, muscle cramps, deep burning pain, tingling sensations and numbness. Patients are 40x more likely to have complications and therefore have high risk of amputation.
SIGNS and SYMPTOMS
The most common and important symptoms are polydipsia, polyuria, polyphagia, weight loss and loss of strength. But the most common and objective sign is fasting blood glucose. There is an increase to 126mg/100mltopeak value of 200mg/100ml. There is a delayed return to normal 2 hour. There are further diagnosticcriteria for diabetes but for this, purpose only the pertinent will be tackled.
Dental management depend on the level of diabetes. Patients who havecontrolled diabetes generally have no contraindications to oral surgery. Unless of course they developed severe dental infection. There should be, of course, a communication with the physician or endocrinologist.
Patients who have poor functional capacity as evaluated by the medical professional have high risk of serious cardiovascular complications. This can be observed as with complications and cardiovascular disease. Some patients who may also be of concern are those who haven’t seen a physician and who report unstable symptoms.
If after clearance from the physician, then the patient may undergo oral surgery. Dental appointments should be early. The patient should take insulin and eat normal meals to prevent insulin shock. Patients should also be given special dietary instructions. There should be normal diet except that the food should be blended to prevent further trauma to the post-operative side.
Management would be different for those patients who have high insulin dosage. They are also at higher risk to developing infections. Since the goal of treatment is to decrease the tendency for infection, then prophylactic antibiotics may be necessary to those who have 206mg/100ml and aboves. If FBS is as high as 230mg/100ml,there is an 80% riskfor infection for oral surgery.d
Since the goal of dental treatment is to decrease the amount or probability of infection in the oral cavity, then extra precaution is necessary. In retrospect, proper diagnosis of the glycemic control and proper patient evaluation of the level of diabetes should be done before any surgical procedures. If the condition is well-maintained and the procedure is approved by the physician, then oral surgery may be done but with caution of no collateral damage to adjacent tissues. In this way, infection may be prevented