Individuals with type 2 diabetes (T2D) have normal, increased, or decreased insulin levels due to abnormal beta cell function. The need for exogenous insulin in T2D is variable. Individuals with T2D may be able to control their blood glucose levels with medical nutrition therapy (MNT) and exercise only, with the aid of antidiabetic medication, and/or insulin injections.
The result of T2D is hyperglycemia, insulin resistance, and/or hyperinsulinemia. Like T1D, individuals with T2D can be diagnosed at any age but typically after the age of 30. The number of adolescents with T2D is on the rise, particularly in the African American, Native American, and Hispanic population groups. Most importantly, T2D can be delayed or prevented with lifestyle modifications, such as awareness of appropriate dietary intake, physical activity, and weight control.
Insulin levels increase slowly in many individuals with T2D causing the symptoms to appear slowly and not easily noticeable. It may be years before a diagnosis is uncovered. The time difference between the initial hyperglycemia and diagnosis averages around 6.5 years, therefore, it is common for individuals to have characteristics of long-term complications prior to diagnosis.7 In addition to asking about symptoms related to hyper- or hypoglycemia, the medical history should include questions regarding indications of the long-term complications.
Dental professionals should be aware of hyperosmolar hyperglycemic state (HHS). It is a life-threatening medical emergency associated with type 2 diabetes in which blood glucose values are typically greater than 600 mg/dL. Signs and symptoms include dehydration and neurologic dysfunction. In addition, when compounded by other health demands (e.g., infection) or use of certain medications (e.g., corticosteroids), individuals with T2D are at risk of DKA.
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