there is a genetic predisposition, there may well be a triggering effect from viral
infections in the aetiology of diabetes. The clinical manifestations are polydipsia
(increased thirst), polyuria (increased urination), polyphagia (increased appetite), and
weight loss. There may be an insidious onset of lethargy, weakness, and weight loss.
The diagnosis is dependent on the demonstration of hyperglycaemia in association
with glucosuria. The aims of treatment are to control the symptoms, prevent acute
metabolic crises of hypo- and hyperglycaemia, and to maintain normal growth and
body weight, with an active life-style. If there is good control of blood sugar levels
with insulin therapy and nutritional management, then diabetic complications are
minimized. One of the major hazards of insulin treatment is the development of
hypoglycaemia. It is usually of rapid onset (unlike hyperglycaemia) with sweating,
palpitations, apprehension, and trembling. This progresses to mental confusion,
drowsiness, and coma. Hypoglycaemia in a diabetic child indicates too much insulin
relative to food intake and energy expenditure. For an acute episode a carbohydrate-
containing snack or drink should be given. Another problem, particularly in
adolescents, is the psychological adjustment to the condition; the rebellious teenage
years may lead to non-compliance with insulin therapy and nutritional management.
Many of these problems can be averted by suitable education and counselling.
Dental management of diabetes
The well-controlled diabetic child with no serious complications can have any dental
treatment but should receive preventive care as a priority. Uncontrolled diabetes can
result in varied problems, which mainly relate to fluid imbalance, an altered response
to infection, possible increased glucose concentrations in saliva, and microvascular
changes. There may be decreased salivary flow, and an increased incidence of dental
caries has been reported in uncontrolled young diabetics. There is also well-
documented evidence of increased periodontal problems and susceptibility to
infections, particularly with Candida sp. Dental appointments should be arranged at
times when the blood sugar levels are well controlled; usually a good time is in the
morning immediately following their insulin injection and a normal breakfast.
General anaesthetics are a problem because of the pre-anaesthetic fasting that is
required, and so these are normally carried out on an in-patient basis to enable the
insulin and carbohydrate balance to be stabilized intravenously.
16.6.2 Adrenal insufficiency
There are a number of syndromes associated with adrenal insufficiency, such as
Addison's disease and Cushing's syndrome. However, problems in the dental
management of patients with steroid insufficiency are more likely to occur in children
who are being prescribed steroid therapy for other medical conditions; for example, in
the suppression of inflammatory and allergic disorders, acute leukaemia, and to
prevent acute transplant rejection. In children, the risks of taking corticosteroids are
greater than in adults and they should only be used when specifically indicated, in
minimal dosage, and for the shortest possible time. If a child has adrenal insufficiency
and/or is receiving steroid therapy, then any infection or stress may precipitate an
adrenal crisis. For routine restorative treatment no additional steroid supplementation
is usually necessary. However, if extractions under local anaesthesia or more
extensive procedures are planned and/or if the patient is particularly apprehensive,
then the oral steroid dosage should be increased. General anaesthesia should not be