Acute%20Infections%20and%20Insulin%20Requirements

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Acute Infections and Insulin Requirements

• In pre-diabetic individuals acute infections may
• induce a temporary state of diabetes requiring
• short-term insulin therapy
• Pelvic inflammatory disease
• Pneumonia
• Encephalitis
• Nephritis
• Bacterial endocarditis
• Appendicitis

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Insulin Resistance Atherosclerosis Study

• Provided information demonstrating that
  inflammation (CRP) is associated with insulin
  sensitivity even in people without diabetes
• Higher levels of CRP were associated with a
  greater degree of insulin resistance
• Serum levels of CRP and other markers of
  inflammation were significantly related to the
  development of type 2 diabetes in 1,047
  non-diabetic subjects followed for 5 years
• The investigators concluded that chronic
  inflammation has emerged as a new risk factor for
  type 2 diabetes

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An Investigation on the Contribution of
Periodontal Disease to Insulin Resistance

• 10 subjects with varying degrees of insulin
  resistance, consented to a clinical periodontal
  evaluation, genetic testing for an IL-1
  polymorphism and to biochemical analysis of oral
  mouth rinse samples
• Insulin Resistance was measured using a
  hyperinsulinemic euglycemic clamp to determine RD
  values which is a measure of glucose uptake and
  insulin sensitivity
• Levels of IL-1b, IL-8 and VEGF in the mouth rinse
  samples were measured using Fluorokine
  Multi-analyte profiling (MAP) kits (RD Systems)
  on a Luminex analyzer
• DNA analysis was performed to determine if these
  subjects had a specific variation in the genes
  that regulate IL-1 (Kornman et al.)

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Findings

• 50 of the subjects tested positive for the IL-1
  polymorphism
• These same 5/10 subjects had 35-83 sites with
  attachment loss gt5mm and were qualified as very
  insulin resistant with an RD value of lt8.
• 4 subjects had 15-32 sites of attachment loss
  gt5mm and were qualified as insulin resistant with
  RD values of 8-10
• 1 subject had 10 sites with attachment loss of
  gt5mm and was qualified as average with an RD
  value of 11.98

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Periodontitis and DiabetesA two-way street

• Diabetics are at an increased risk for
  developing infections
• Periodontitis is known to be a complication of
  diabetes
• Infections lead to impaired diabetic control
• Periodontitis can impair a diabetic patients
  ability to process and/or utilize insulin

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Diabetes MellitusPrevalence

• Approximately 20.8 million Americans
• 6-7 of the population
• Half are unaware that they have the disease
• Pre-diabetes is also on the rise
• The number of cases in the U.S. continues to rise
• Due to increasing population and life expectancy
• Increased prevalence of obesity
• The practicing dentist
• Will encounter patients with diabetes and
  pre-diabetes
• A practice of 2000 patients may have 120-140
  diabetic patients
• Approximately 50 will be aware of their
  condition
• Practices being referred diabetic patients will
  have much higher numbers
• Can oral health providers aid in the
  identification and management of people with
  diabetes?

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Diabetes MellitusCan Dentists Help?

• Identify the classic signs and symptoms
• Identify oral manifestations
• Perform a risk assessment
• Ask, advise and refer patients to the physician
• Laboratory Methods (to be confirmed on subsequent
  day)
• Classic symptoms and casual (non-fasting) plasma
  glucose gt200 mg/dL
• Fasting plasma glucose gt126 mg/dL
• Categories of fasting plasma glucose (FPG)
• FPG lt110 mg/dL normal fasting glucose
• FPG gt 110 mg/dL and lt126 mg/dL Impaired fasting
  glucose (IFG)
• FPG gt126 mg/dL provisional diagnosis of
  diabetes (confirmed on next day)

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Diabetes MellitusClassic Signs and Symptoms

• Polydipsia, polyuria, nocturia, polyphagia
• Unexplained weight loss
• General fatigue
• Increased infections
• Leg cramps
• Numbness in the extremities
• Impotence
• Blurred vision

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Diabetes MellitusRisk Assessment

• gt 45 years
• Obesity
• Family history of type 2 diabetes
• Racial decent
• History of GDM or a history of delivering a baby
  gt 9 lbs
• History of impaired glucose tolerance or impaired
  fasting glucose
• Hypertension (gt140/90)
• Dyslipidemia (HDL cholesterol lt35mgdL or
  triglyceride level gt250mgdL)

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Gestational Diabetes

• Usually develops in 3rd trimester
• 2-3 of pregnancies
• Similar pathophysiology to type 2 DM
• Requires intensive monitoring treatment
• Patient returns to normal after delivery
• 30-50 develop type 2 within 10 years

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Diabetes MellitusClassic Complications

• Macrovascular disease (accelerated
  atherosclerosis)
• Peripheral
• Cardiovascular (coronary artery disease)
• Cerebrovascular (stroke)
• Nephropathy
• Renal failure
• Neuropathy
• Sensory (peripheral is most common)
• Autonomic (dysrhythmias, alterations in BP,
  genitourinary, gastroparesis)
• Retinopathy
• Blindness, Blurred vision
• Altered Wound Healing
• Periodontitis

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