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Endocrine Disease:Diabetes |
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Diabetes Mellitus Diabetes Mellitus is a group of metabolic disorders characterised by chronic hyperglycaemia resulting from resulting from relative insulin deficiency, insulin resistance or both.
Insulin dependent Diabetes Mellitus (type I) Presents in childhood, autoimmune destruction of Beta cells of the pancreas. Linked to HLA-DR3. Complete insulin deficiency and life-long insulin replacement therapy.
Non-insulin dependent Diabetes Mellitus (type II) Patients usually older> 40years. Overweight, no HLA links. Partial insulin deficiency and peripheral insulin resistance. Sometimes need insulin.
Secondary diabetes Pancreatic disease, endocrine disease (Cushing’s), drug-induced:Thiazide, corticosteroids.
Symptoms: Polyuria, thirst, weight loss, lethargy Diagnosis: raised fasting venous blood glucose> 6.7mmol/l or random blood glucose >10mmol/l.
Oral manifestations ¨ Poor periodontal health ¨ Dry mouth and sialosis ¨ Glossitis and change to filliform papillae ¨ Drugs: Chlorpropramide, implicated in oral mucosal lichenoid reactions ¨ Candidosis: poorly controlled diabetes ¨ Mucormycosis of the paranasal sinuses and nasal cavity is associated with severe diabetes
Surgery in the diabetic patient Increased secretion of counter-regulatory hormones such as cortisol, catecholamine and glucagons, decreased insulin secretion and increased insulin resistance. The diabetic patient should be first on the list. See Diabetic Sliding Scale.
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