One in 10 Americans — or more than 30 million people — have diabetes, according to the Office of Disease Prevent and Health Promotion (healthfinder.gov). People with diabetes have an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums. These bacteria are what cause periodontal disease, a chronic, inflammatory condition that can destroy your gums, all the tissues holding your teeth, and even your bones. The American Dental Association states that periodontal disease is the most common dental disease among those living with diabetes, affecting nearly 22 percent of those diagnosed. In fact, one in five cases of total tooth loss is related to diabetes. 

Dental complications due to diabetes also include oral burning — a burning sensation inside the mouth that may include a bitter taste and dry mouth that is caused by uncontrolled blood glucose levels — and thrush — the growth of a naturally occurring fungus that the body is unable to control and may cause sore, white — or sometimes red — patches on your gums, tongue, cheeks, or the roof of your mouth.

November is American Diabetes Month, and Carolina’s Dental Choice wants to help you ensure that your efforts to manage the condition include your oral health.

Even if you don’t have diabetes now, that doesn’t mean that you never will. Or, if you’re not someone who regularly goes to the doctor, you could even have diabetes and not know it yet. Approximately 1.7 million new cases are diagnosed each year — and 8.1 million people living with diabetes don’t even know they have it. Another 84 million adults in the United States are at high risk of developing type 2 diabetes.

HOW DIABETES WORKS

There are common misconceptions about diabetes. Diabetes is not simply caused by eating too much sugar. It is not a disease only seen in people who are overweight.

Diabetes is a disease in which the pancreas, a gland situated behind and below the stomach, does not properly produce the hormone insulin. What is supposed to happen is that when you eat food that food is digested in the stomach and broken down and converted into glucose, a type of sugar. That sugar is required for your body to function. The stomach and small intestines absorb the glucose and then release it into the bloodstream. Once in the bloodstream, glucose can be used immediately for energy or stored in our bodies, to be used later. However, in order to store the glucose for later, the body must have insulin. Think of it almost as if food is like going to work, cash is glucose, and your savings account and ability to retire is insulin. Without the savings account, all the cash gets spent!

HOW DIABETES DEVELOPS

It is thought a combination of genetic susceptibility and environmental factors cause type 1 diabetes though exactly what those factors are is still unclear. What’s known is that in type 1 diabetes, your immune system attacks and destroys your insulin-producing cells in the pancreas, leaving you with little or no insulin. Consequently, diabetes can be thought of as an autoimmune disease. You may be familiar with other autoimmune diseases such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, or lupus.

It’s believed that genetic and environmental factors also play a role in the development of type 2 diabetes — although being overweight is strongly linked to the development of type 2 diabetes. In type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. 

RISK FACTORS FOR DIABETES

The Mayo Clinic outlines certain risk factors for developing type 2 diabetes:

• Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Family history. Your risk increases if a parent or sibling has type 2 diabetes.
• Race. Although it’s unclear why, people of certain races — including black people, Hispanics, American Indians and Asian-Americans — are at higher risk.
• Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing among children, adolescents and younger adults.
• Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
• High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or “good,” cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.

SYMPTOMS OF DIABETES

According to the Mayo Clinic, Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it’s more common in people older than 40.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

In addition to gum infections, you can look for other symptoms to show up in your mouth, if diabetes is left untreated, explains the American Dental Association.

• You may have less saliva, causing your mouth to feel dry.
• Because saliva protects your teeth, you’re also at a higher risk of cavities.
• Gums may become inflamed and bleed often, which is called gingivitis.
• You may have problems tasting food.
• You may experience delayed wound healing (such as when you bite the inside of your cheek or have a tooth pulled).
• You may be susceptible to infections inside of your mouth.
• For children with diabetes, teeth may erupt at an age earlier than is typical.

Note that dry mouth isn’t just an annoyance. It can impact your oral health. Certain medications and other conditions can cause dry mouth, but symptoms include:

• A sticky, dry feeling in the mouth
• Trouble chewing, swallowing, tasting, or speaking
• A burning feeling in the mouth
• A dry feeling in the throat
• Cracked lips
• A dry, rough tongue
• Mouth sores
• An infection in the mouth
• Bad breath

EFFECTS OF DIABETES

Most people have felt the short term effects of their blood sugar getting too high (hyperglycemia) or too low (hypoglycemia) such as when eating too much, being sick, experiencing a lot of stress, exercising too much, or not eating enough.

Early hyperglycemia may result in frequent urination, increased thirst, blurred vision, fatigue, and headaches. More severe hyperglycemia may include nausea, vomiting, dry mouth, shortness of breath, and abdominal pain.

Mild hypoglycemia can make you feel hungry or like you want to vomit. You could also feel jittery or nervous. Your heart may beat fast. You may sweat. Or your skin might turn cold and clammy. Moderate hypoglycemia often makes people feel short-tempered, nervous, afraid, or confused. Your vision may blur. You could also feel unsteady or have trouble walking. Severe hypoglycemia can cause you to pass out. You could have seizures. It could even cause a coma or death. If you’ve had hypoglycemia during the night, you may wake up tired or with a headache. And you may have nightmares. Or you may sweat so much during the night that your pajamas or sheets are damp when you wake up.

With diabetes it is not simply a matter of a person having only too much or only too little blood sugar, its that the body can not regulate blood sugar levels. Wild swings in blood sugar can have profound physical effects.

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.
  Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer’s disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
• Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

MANAGING & PREVENTING DIABETES

For a person with diabetes, the main focus of treatment is to control the amount of glucose in the body so that blood sugar levels stay as close to normal as possible.

Type 1 diabetes can’t be prevented. However, healthy lifestyle choices can help prevent type 2 diabetes.

• Lose weight if you are overweight, and keep it off. You may be able to prevent or delay diabetes by losing 5 to 7 percent of your current weight.1 For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds.
• Move more. Get at least 30 minutes of physical activity, such as walking, at least 5 days a week. If you have not been active, talk with your health care professional about which activities are best. Start slowly and build up to your goal.
• Eat healthy foods. Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages.

For tips on living with diabetes and caring for your oral health, you can also download tips from the National Institute of Oral and Craniofacial Research:

• In English
• In Spanish

Talk to your dental hygienist and dentist at Carolina’s Dental Choice, if you have diabetes or have been experiencing any of the oral symptoms of diabetes such as dry mouth, gingivitis, or trouble tasting food. We can make recommendations to help you best manage your oral health now and in the future.