Recommended management strategies for diabetics

Not all diabetic patients require insulin. The determining factor depends upon the pancreas’s ability to manufacture sufficient insulin on its own. If so, oral or injected insulin is not required. It is required, however, for patients diagnosed with type 1 diabetes and for those with type 2 diabetes who do not respond to dietary and exercise therapy alone. Diet and physical exercise, along with weight control, are all necessary components of diabetes management.

Overall, there are three effective management strategies the hygienist can instill to help diabetic patients manage their disease:

1. Planned meals, choosing what, how much, and when to eat (to maintain recommended glucose levels).
2. Being physically active (exercise actually lowers blood sugar) on a regular basis.
3. Taking prescribed medications (if needed).

In meeting these three self-management strategies the anticipated outcomes for the patient are normalized blood glucose levels; prevention of acute complications and elimination of symptoms of the disease; maintenance of ideal body weight; and prevention or minimization of chronic complications.

Home glucose monitoring helps diabetics regulate rapid fluxes in blood sugar levels contingent upon diet, medications, and physical and psychological stresses. Daily recording of premeal and (two hours) postmeal glucose levels helps the diabetic learn to adjust dietary intake, especially high-starch carbohydrates, as well as overall caloric intake. Diabetic patients should undergo routine examinations by physicians to monitor triglycerides, blood pressure, urine protein, and fasting and long-term glucose levels.

The hygienist, as well as all members of the dental team, should be aware of treatment needs and concerns of oral manifestations of diabetic patients. In some cases, patients are unaware of their diabetes, and a visit to the dental office may alert the dentist to refer a suspected undiagnosed diabetic to his or her physician for assessment. Because diabetes is on the rise, both in adolescents and in adults, dental offices are more likely to treat an increasing number of diabetic patients in the future.

Today, all three patients are doing well. The young girl has had an insulin pump implanted. She is enrolled in her freshman year of college and is an active athlete. She tests her glucose levels 10 times daily.

The teenager is currently enrolled in law school. He plans to earn his doctorate and become a law professor. He tests his glucose 10 times daily and takes oral insulin daily.

The “couch potato” middle-aged lady said, “This was the wake-up call of a lifetime.” She brought down her weight, glucose levels, and blood pressure through diet and exercise, alone. She realizes someday she may need to be on medication; however, she credits her primary care provider and nutrition counselor for early interception and for putting her on the right track. Today she is looking forward to retirement and traveling with her husband; she enjoys playing with her first grandchild.