DIABETES- A COSTLY DISEASE
DIABETES?
Diabetes
mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result
from defects in insulin secretion, or action, or both. Diabetes mellitus,
commonly referred to as diabetes (as it will be in this article) was first
identified as a disease associated with "sweet
urine," and excessive muscle loss in the ancient world.
Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose
into the urine, hence the term sweet urine.
Normally,
blood glucose levels are tightly controlled by insulin, a hormone produced by
the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates
(for example, after eating food), insulin is released from the pancreas to
normalize the glucose level. In patients with diabetes, the absence or
insufficient production of insulin causes hyperglycemia. Diabetes is a chronic
medical condition, meaning that although it can be controlled, it lasts a
lifetime.
IMPACT
OF DIABETES.
Over
time, diabetes can lead to blindness, kidney failure, and nerve damage. These
types of damage are the result of damage to small vessels, referred to as microvascular
disease. Diabetes is also an important factor in accelerating the hardening and
narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart
disease, and other large blood vessel diseases. This is referred to as
macrovascular disease. Diabetes affects approximately 17 million people (about
8% of the population) in the United States. In addition, an estimated
additional 12 million people in the United States have diabetes and don't even
know it.
From
an economic perspective, the total annual cost of diabetes in 1997 was
estimated to be 98 billion dollars in the United States. The per capita cost
resulting from diabetes in 1997 amounted to $10,071.00; while healthcare costs
for people without diabetes incurred a per capita cost of $2,699.00. During
this same year, 13.9 million days of hospital stay were attributed to diabetes,
while 30.3 million physician office visits were diabetes related. Remember,
these numbers reflect only the population in the United States. Globally, the statistics
are staggering
Diabetes is the third leading cause of death in the United
States after heart disease and cancer
WHAT
ARE THE DIFFERENT TYPES OF DIABETES?
There
are two major types of diabetes, called type 1 and type 2.
Type 1 diabetes
was also called insulin dependent diabetes mellitus (IDDM), or juvenile onset
diabetes mellitus. In type 1 diabetes, the pancreas undergoes an autoimmune
attack by the body itself, and is rendered incapable of making insulin.
It
is believed that the tendency to develop abnormal antibodies in type 1 diabetes
is, in part, genetically inherited, though the details are not fully
understood..
Type 2 diabetes
was also referred to as non-insulin dependent diabetes mellitus (NIDDM), or
adult onset diabetes mellitus (AODM). In type 2 diabetes, patients can still
produce insulin, but do so relatively inadequately for their body's needs,
particularly in the face of insulin resistance A major feature of type 2
diabetes is a lack of sensitivity to insulin by the cells of the body
(particularly fat and muscle cells).
In
addition to the problems with an increase in insulin resistance, the release of
insulin by the pancreas may also be defective and suboptimal.
Gestational diabetes-
Diabetes can occur temporarily during pregnancy and usually resolves once the
baby is born.
"Secondary" diabetes refers to elevated blood sugar levels from another
medical condition. Secondary diabetes may develop when the pancreatic tissue
responsible for the production of insulin is destroyed by disease, such as
chronic pancreatitis (inflammation of the pancreas by toxins like excessive
alcohol), trauma, or surgical removal of the pancreas.
Diabetes
can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and
Cushing's syndrome. In acromegaly, a pituitary gland tumor at the
base of the brain causes excessive production of growth hormone, leading to
hyperglycemia. In Cushing's syndrome, the adrenal glands produce an excess of
cortisol, which promotes blood sugar elevation.
In
addition, certain medications may worsen
diabetes control, or "unmask" latent diabetes. This is
seen most commonly when steroid medications (such as prednisone) are taken and
also with medications used in the treatment of HIV infection (AIDS).
CAUSES OF DIABETES
Insufficient production of insulin (either absolutely or relative
to the body's needs), production of defective insulin (which is uncommon), or
the inability of cells to use insulin properly and efficiently leads to
hyperglycemia and diabetes. This latter condition affects mostly the cells of
muscle and fat tissues, and results in a condition known as "insulin
resistance.", if someone is resistant to insulin, the body can, to some
degree, increase production of insulin and overcome the level of resistance.
After time, if production decreases and insulin cannot be released as
vigorously, hyperglycemia develops.
Without insulin, the cells become starved of
glucose energy despite the presence of abundant glucose in the bloodstream. In
certain types of diabetes, the cells' inability
to utilize glucose gives rise to the ironic situation of "starvation in
the midst of plenty". The abundant, unutilized glucose is wastefully
excreted in the urine.
SYMPTOMS
OF DIABETES
The
early symptoms of untreated diabetes are related to elevated blood sugar
levels, and loss of glucose in the urine. High amounts of glucose in the urine
can cause increased urine output and lead to dehydration. Dehydration causes
increased thirst and water consumption.
The
inability of insulin to perform normally has effects on protein, fat and
carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that
encourages storage of fat and protein.
A
relative or absolute insulin deficiency
eventually leads to weight loss despite an increase in appetite.
Some
untreated diabetes patients also complain of fatigue,
nausea and vomiting.
Patients
with diabetes are prone to developing infections
of the bladder, skin, and vaginal areas.
Fluctuations
in blood glucose levels can lead to blurred
vision. Extremely elevated glucose levels can lead to lethargy and coma.
ORAL
MANIFESTATION OF DIABETES MELLITUS
No
specific oral lesion is related to diabetes. However in uncontrolled Diabetes effects can be dramatic. People with Diabetes
can have
·
Rapidly
progressive Periodontal disease
·
Gingivitis
·
Oral
Candidiasis(thrush)
·
Dry
mouth (Xerostomia)
·
Burning
sensation of oral and tongue mucosa
·
Poor
healing of oral ulcers and wounds.
·
Never
read anywhere but there is a slight increase in dental decay probably due to
Xerostomia
·
And
multiple teeth showing periapical lesions
TREATMENTS
Would
not go into the details of treatments related to this disease but would advice
every dentist to always keep a consideration that any of your patient could
have diabetes so always monitor their reports before and during Dental
treatment.
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