51

The Diabetic Child

Diabetes Mellitus

This is a common condition affecting at least 2% of the British population and up to 6% of the population of the USA. It encompasses a group of metabolic disorders characterised by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both.

Types Affecting Children

• Type 1 diabetes mellitus (insulin-dependent diabetes mellitus, IDDM); also known as juvenile-onset diabetes, accounting for 5% of all cases.
• Type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus, NIDDM); also known as maturity-onset diabetes, type 2 accounts for 95% of all cases of diabetes mellitus. Onset is usually in mid or later life, although it can occur earlier. It develops mainly through a combination of insulin resistance and defective B-cell function. It may remain asymptomatic until diagnosed by a routine blood or urine test.
• Maturity-onset diabetes of youth (MODY), a rare, inherited form of type 2 diabetes that usually affects teenagers.

Blood Glucose Range

The normal blood glucose level is 3.9–6.1 mmol/l.

WHO range of blood glucose indicative of diabetes mellitus is as follows:

• fasting plasma glucose (FPG) ≥7.0 mmol/l;
• plasma glucose ≥11.1 mmol/l at 2 hours after a 75 g oral glucose load (oral glucose tolerance test, OGTT).

Dental Management

The following advice mainly applies to IDDM. The main concern about treating people with diabetes is their potential for collapse due to hypoglycaemia and, less commonly, hyperglycaemia. Diabetic emergencies are summarised in Table 51.1. The effect of untreated oral disease on diabetes is shown in Table 51.2.

Table 51.1 Diabetic emergencies.

Data from Scully and Cawson, 2005 and McKenna, 2006.

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