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Management of Patients with Chronic Diseases

Course Number: 567


A chronic metabolic disease affecting how the body turns food into energy resulting in too much sugar in the blood (high blood glucose).48 There are several types of diabetes. Type 1 is an autoimmune disease where the pancreas does not make enough insulin. Type 2 is a condition where the body cannot use the insulin which it makes (insulin resistance).48 Sometimes women develop type 2 diabetes during pregnancy. This condition is called gestational diabetes. Uncontrolled diabetes can result in hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). Hypoglycemia can result in unconsciousness, coma, or death. Clinical signs and symptoms of diabetes are summarized in Figure 10.

Figure 10. Clinical Signs and Symptoms of Diabetes.48

  • Urinate a lot, often at night
  • Are very thirsty
  • Smell of acetone (sweet, fruity odor) on breath
  • Lose weight without trying
  • Are very hungry
  • Have blurry vision
  • Have numb or tingling hands or feet
  • Feel very tired
  • Have very dry skin
  • Have sores that heal slowly
  • Have more infections than usual
  • Elevated blood sugar
  • Type 1 diabetes may also cause nausea, vomiting, and stomach pain
  • Gestational diabetes typically has no symptoms

Epidemiology and Etiology

More than 122 million Americans are living with diabetes (34.2 million) or prediabetes (88 million).48,100 It is the most common endocrine disease. The risk factors for developing this condition differ depending on the type of diabetes that is present. However, having a family history of diabetes (a parent or sibling) is a common risk factor among all types of diabetes. Figure 11 provides additional statistics and risk factors about this disease.

Figure 11. Diabetes Statistics and Risk Factors.

Type 1 diabetes

  • Family history
  • Can develop at any age but it’s more likely to develop in children, teens, and young adults

Type 2 diabetes

  • Family history
  • Prediabetes (symptomless slightly elevated blood sugar levels)
  • Overweight
  • Age 45 years or older
  • Physical activity less than 3 times a week
  • History of gestational diabetes or given birth to a baby who weighed more than 9 pounds
  • African American, Hispanic/Latino American, American Indian, Alaska Native, and some Pacific Islanders and Asian Americans

Gestational diabetes

  • Family history of type 2 diabetes
  • History of gestational diabetes or given birth to a baby who weighed more than 9 pounds
  • Overweight
  • Age 25 years or older
  • History of polycystic ovary syndrome (a hormone disorder)
  • African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander

Patient Management and Oral Health Considerations for Diabetes

When providing care to patients diagnosed with diabetes, dental providers must be mindful of the patient’s blood glucose levels. Dental procedures can cause physiological and psychological stress, which increases the risk for developing hyperglycemia. Epinephrine 1:100,000 is typically well tolerated; however, the pharmacologic effect can increase blood glucose levels.49 Generally morning appointments are most suitable because there is a lower risk for hypoglycemia.50 Long-term control of blood glucose levels is evaluated by measuring the extent of glycosylation of hemoglobin A in red blood cells which forms HbA1c. HbA1c levels are normally 6-8%. Measurements below 7% indicate the patient’s diabetes is well controlled.48 It is advisable for dental providers to keep a glucose meter in the office to check a patient’s blood glucose level when needed. If a glucose meter is not available, dental providers should ask the patient to bring their glucose meter to appointments. Dental providers should ask the patient when their last meal was and compare that to the patient’s typical meal times. They should also confirm that the patient has taken all regularly scheduled medications including insulin. It is advisable to have a 15-20 grams of an oral fast acting carbohydrate readily available to administer when blood glucose levels fall below 70 milligrams per deciliter (mg/dL).51,52

Patients diagnosed with diabetes may experience accelerated periodontal disease, gingival proliferations, periodontal abscesses, xerostomia, poor healing, infection, oral ulcerations, candidiasis, numbness, burning mouth syndrome, and pain in the oral cavity.42,53These conditions may be more severe in patients who do not have good glycemic control. Patients who have not yet been diagnosed may present with oral problems that can be one of the first signs of disease. Dental providers that observe conditions, such as poor healing after having a tooth removed or periodontal therapy, should talk with their patient about diabetes and see if any of the clinical signs and symptoms are present.54