Wednesday, April 04, 2007

Diabetes: Anyone, anytime

While age, family history, obesity, and a "couch potato" lifestyle are the most common contributing factors of type 2 diabetes, the disease may hit anyone, even where there is no family history. As most often the first clinical contact with new patients, the first team member to observe the oral manifestations associated with diabetes.

On Monday morning a 14-year-old girl presents with general malaise and oral candidiasis. Her parents report she has felt this way all weekend and that she has lost seven pounds - inexplicably - during that time. There was no family history of diabetes.

A teenage boy claims to feel weak and ill. His parents take him to the family physician who attributes his symptoms to growing pains and a touch of the flu. Later that week he collapses on the pitcher’s mound at a baseball game. The paramedics cannot revive him. They call a medevac helicopter and tell his parents to meet them at the hospital, where there will be a 50-50 chance they will find him alive. An emergency room nurse asks if there is a family history of diabetes, to which the parents respond no. Soon afterward the parents learn their son’s blood sugars are in the 600s! He is, indeed, lucky to be alive!

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A 55-year-old obese woman with a sedentary lifestyle complains of blurred vision, lack of taste, frequent urination, fatigue, and an insatiable thirst. In fact, she carries a water bottle with her throughout the day. Her 24-hour urine collection analysis reveals no kidney damage; however, her fasting bloodwork reveals her glucose level at 167; her long-term A1C is 7.1.

In each of these cases, the patient was diagnosed with diabetes. The sad fact is that diabetes is occurring in epic proportions from a generation ago. And while age, obesity, family history, and a “couch potato” lifestyle are the most common contributing factors, diabetes may hit anyone, even where there is no family history.

Because the hygienist is often the first clinical contact with new patients, it behooves him or her to be vigilant to the oral signs and symptoms of diabetes. This is to alert the dentist, who, upon further examination, may refer the patient to his or her physician for follow-up assessment.

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