Diabetes mellitus occurs when the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine. Glucose is the energy source for cells in the human body. In order for cells to process glucose in the intracellular mitochondria, the glucose must first cross the cell membrane. Since glucose cannot cross the cell membrane, it “piggy backs” a ride across the cell membrane attached to insulin, which can cross the cell membrane.
In type 1 diabetes, the pancreas does not produce insulin. The latest scientific information states that type1 diabetes mellitus is a condition caused by inflammation. The immune system attacks a virus that has an antigenic makeup very similar to the cells in the pancreas that produce insulin (beta cells in the Islets of Langerhans). Thus, the insulin producing cells in the pancreas are also attacked and destroyed (cross antigenicity).
In type 2 diabetes, the pancreas produces insulin but the cells are resistant to insulin.
In both types of diabetes, glucose cannot enter the cell and unsafe amounts of glucose accumulate in the blood and urine. 95% of diabetes is type 2 and 5% type 1. Cellular and molecular processes in the human body do not function properly in an environment of elevated blood glucose. It’s ironic that the cells are starving for glucose and cannot get it, while there is an excessive amount of glucose in the blood.
Common tests to evaluate glucose metabolism include:
Fasting or random blood sugar tests check the blood glucose at one given point in time. It can be helpful in emergency situations where the blood glucose level needs to be quickly evaluated at that point in time.
Hemoglobin A1C (HbA1C) measures the average glucose level over an extended period of time (usually 3 months). This gives the medical expert (usually an internist or endocrinologist) a more representative assessment of the blood glucose level under different circumstances over a period of time.
Glucose tolerance test (GTT). In this test a large amount of glucose is given to the patient orally. And then blood glucose levels are measured at given points in time. This will demonstrate the body’s ability to metabolize glucose.
Common treatments for diabetes include:
Diet (low in sugar) and exercise are usually the first lines of treatment. The body metabolizes glucose more efficiently if a person is on a regular exercise program and has a diet low in sugar. If this doesn’t work, then oral medication may be added to the regimen. Then, finally, if these measures do not work, insulin is administered by a needle injection or insulin pump. An insulin pump is a sophisticated electronic device that continuously monitors blood sugar and automatically dispenses insulin in an appropriate amount to keep the blood sugar in an acceptable range.
RELATIONSHIP OF PERIODONTAL DISEASE TO MANAGEMENT OF DIABETES:
Periodontal disease is episodic. In other words, there are peaks and valleys of periodontal activity. As periodontal activity fluctuates > immunological activity fluctuates > blood glucose fluctuates > insulin fluctuates. This metabolic chaos is initiated with the inflammation associated with periodontal disease. Therefore, it is difficult, if not impossible to properly manage diabetes in the presence of active untreated periodontal disease.
At Britt Perio, we have effective methods to prevent and control periodontal inflammation to result in better management of diabetes mellitus.