The Dental Patient with Diabetes

Chapter Nine - Diagnosis

Chapter 1: Glucose Metabolism and Hormonal Regulation Review

Chapter 2: Diabetes Mellitus

Chapter 3: Diabetes Mellitus Type 1

Chapter 4: Diabetes Mellitus Type 2

Chapter 5: Gestational Diabetes Mellitus (GDM)

Chapter 6: Pre Diabetes: Impaired Glucose Homeostasis

Chapter 7: Other Specific Types of Diabetes

Chapter 8: Diagnosing Diabetes

Chapter 9: Diagnosis

Chapter 10: Glucose Monitoring

Chapter 11: Complications of Diabetes

Chapter 12: The Dental Patient with Diabetes

Chapter 13: Successful Intervention of Diabetic Emergencies

Chapter 14: Prevention and Treatment of DM

Chapter 15: Diabetes Medications

Chapter 16: Conclusion

The diagnosis of diabetes is made based on the excessive level of glucose in the blood.

The three ways to diagnose diabetes are as follows:

Symptoms of diabetes plus casual plasma glucose concentration 200 mg/dL.
(Symptoms present as classic symptoms of diabetes: polydypsia, polyuria and unexplained weight loss. Casual is defined as being measured at any time of day without regard to time since last meal)

Or
Fasting Plasma Glucose (FPG) 126 mg/dL.
(Fasting is defined as no caloric intake for at least 8 hours)

Or
2hPG 200 mg/dL during an Oral Glucose Tolerance Test (OGTT).
(2hPG is defined as two-hour postload glucose sample. The test should be performed using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.)

When the OGTT is used the following criteria apply:

2hPG < 140 mg/dL = Normal glucose
2hPG 140 and < 200 mg/dL = IGT
2hPG 200mg/dL = provisional diagnosis of diabetes

Fasting blood glucose testing is the preferred test, but any one of these three tests may be used to screen for diabetes. To obtain a definitive diagnosis, the same or one of the other tests must be completed on a subsequent day duplicating a positive result. The Expert Committee of the American Diabetes Association's 57^th Annual Scientific Session suggests use of the FPG due to its convenience, lower cost and acceptability to patients. In using the OGTT it is important to note that the cutoff at 140 mg/dL will identify more people as having impaired glucose homeostasis. This fact makes identification of the type of test used to measure blood glucose very important.(3,5,19,20)

Continue on to Chapter 10: Glucose Monitoring