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Concerns

What type of DM do you have?

Is your DM under control?

What types of medications do you take?

How often do you experience hypoglycemic or hyperglycemic episodes, and when was your last episode?

Do you have any cardiovascular or kidney-related complications?

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What type of diabetes do you have?

There are two main types of diabetes mellitus (DM) type 1 (formerly known as insulin dependent or juvenile diabetes) and type 2 (formerly known as non-insulin dependent diabetes).

Type 1 diabetics need insulin for survival. Type 2 diabetics use insulin for glycemic control.

Other types of diabetes include gestational diabetes, which may disappear after the birth of the child but also may be a sign of susceptibility to develop diabetes later in life.

Is your diabetes under control?

Uncontrolled DM is associated with vascular complications that may also include cardiovascular disease, renal disease, and neuropathies.

Poorly controlled DM may also be associated with increased susceptibility to bacterial infections and poor healing.

Long-term glycemic control can be determined with an A1C assay (also known as the glycated hemoglobin A1C assay). Patients with A1C levels <5.7% are considered well controlled.

For additional information, see glucose testing and interpretation.

What types of medications do you take?

Insulin is usually self-injected by patients. It is available in different formulations with different times of onset, peaks of activity, and durations.

There are several oral and other non-insulin hypoglycemic agents and formulations that sometimes may be given with insulin.

Glucocorticosteroids may cause hyperglycemia and should be avoided. Aspirin and aspirin-containing products may enhance the hypoglycemic effect of sulfonylureas.

How often do you experience hypoglycemic or hyperglycemic episodes, and when was your last episode?

Poor glycemic control may result in a state of hypoglycemia or hyperglycemia.

Hypoglycemic patients are at an increased risk of intolerance of dental procedures and may even exhibit hypoglycemic signs and symptoms.

Frequent episodes of hypoglycemia may result in “hypoglycemic unawareness” where patients may not exhibit any of the classic signs and symptoms of hypoglycemia.

An extended period of hyperglycemia will make the patient more susceptible to bacterial infections and oral candidiasis and more likely to exhibit poor wound healing and possibly experience intraoral burning and oral dryness.

Do you have any cardiovascular or kidney-related complications?

Diabetes has been associated with severe complications. These are related to damage of the micro- and macrovascular system and nerves. Compared to nondiabetics, diabetics have a higher prevalence and incidence of visual impairment, blindness, renal failure, stroke, cardiovascular disease, hypertension, nerve damage, and amputations.

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