Diabetes                       Back to the index (top of page)

Diabetes mellitus (DM) affects over 15 million Americans.  The 2 most common forms of diabetes are Type1, also called insulin-dependent diabetes, and Type 2 diabetes, also referred to as non-insulin-dependent diabetes.  Type 1 DM patients absolutely require exogenous insulin injection for survival.  In contrast, Type 2 patients may be treated by diet modification, oral agents, or insulin injections, alone or in combination.  In 1993, a controlled clinical study of over 1,400 Type I DM patients known as the Diabetes Control and Complications Trial (DCCT) provided clear evidence that intensive insulin therapy (3 to 4 injections per day or use of an insulin infusion pump) with a goal of maintaining blood glucose values within the normal range over a prolonged time period markedly reduced the development and progression of retinopathy, nephropathy, and neuropathy by 40 to 75% compared to conventional insulin therapy (1 or 2 injections per day).  The results of the DCCT led the American Diabetes Association to issue a position statement recommending an increased level of glycemic control for Type 1 and most Type 2 patients.  In response, physicians are intensifying treatment regimens for many diabetic patients.

How May Treatment Be Altered For Diabetic Patients?

Prevention of hypoglycemia is paramount, both during and after periodontal treatment.  For most procedures, patients may take their normal dose of insulin or oral hypoglycemic agent as long as they also continue their normal diet.  If pre-treatment diet alteration is needed; for example, before conscious sedation, the physician may be consulted prior to treatment to adjust the medication regimen.  Likewise, if periodontal therapy will adversely affect the patient’s ability to eat, an altered insulin regimen may be indicated. 

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