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Diabetes And Periodontal Disease Ppt

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Periodontitis And Diabetes: A Two-way Relationship

Go to: Abstract Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabeti Continue reading >>

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  1. ForecasterJason

    I am a 21 year old male. I recently got a checkup done and found out my A1C is at 5.7 (fasting blood sugar was 83.) I know my A1c is considered into the range of prediabetes (and my doctor suggested I do more exercise, which I now have been). However, I'm wondering about the accuracy of this. While I do have a family history of pre-diabetes, I don't have much of a family history of actual progression to Type 2 diabetes. Not only is my BMI on the low end (just under 5'8" 126 lbs, putting my BMI at about 19.5), but my body fat is fairly low. My waist, waist to hip, and waist to height measurements are all excellent. My trigylceride and HDL levels are also excellent, and my LDL level is also well within the normal range. Based on my blood work from that visit, my liver tests all came back normal.
    My understanding is that excess glucose is first stored in the liver and muscles as glycogen, and then when those stores are full, the glucose is convered to fat. But clearly, I don't have have a buildup of visceral fat (and pretty sure I never have) that is seen in many individuals with high blood sugar. There are a couple of variables that, while I'm not sure how accurate they are, could complicate the situation. One thing I've read is that African Americans (which is my ethnicity) have higher A1C levels even after adjusting for the same blood glucose levels, though I can't find anything definitive on it that would indicate that African Americans are protected at a higher reading. I've also read that in people whose blood sugars are well controlled, red blood cells live longer, which would increase the hemoglobin reading. This then would drive up the A1c reading. At the time I got all of this blood work done, my hemoglobin was within the normal range, but closer to the high end. All of these factors have me doubting whether I actually have a blood sugar issue, and I'm interested in other thoughts on this. If I really do, it would seem to me as though I would be in an extreme minority given all of my stats and other tests.
    Thanks,

    Jason

  2. t1wayne

    Hi Jason - welcome to the "club" no one wants to join. Even if you wind up not really joining! According to the WHO, the HbA1c test (correctly termed the Haemoglobin Subtype A1c measure) should NOT be used to diagnose "young people" - persons below 25 yrs of age. When it is used, it should be done TWICE, on separate occaisions. A measure at or above 6.5% is indicative of diabetes. Non-D range for the HbA1c is 3.5% to 5.5%, so your 5.7% is barely above normal, and a fasting BG of under 100 mg/dl is in the normal range. So while you may be trending toward D, you are by no means there. Also... even if your doc or anyone else has told you the HbA1c is a measure of your "average blood sugar" over the past 90 days, it's NOT... it's a measure of the percentage of your red blood cells that have glycosylated (bound with sugar molecules) over the past 90 days, and from that an ESTIMATED average blood sugar can be INFERRED, but it's based on large population studies, and your personal "average" may be different.
    The real issue for "prediabetics" is insulin insensitivity - the underlying cause of T2 (type 2 D). To test for this more definitively, the OGTT (Oral Glucose Tolerance Test) is used. In this test, you go to the lab or docs office fasting, they test your BG (it should be under 100 mg/dl) and they feed you 75 g of anhydrous glucose (a really sickly sweet concoction of sugar), then test your BG at 1 and 2 hours after consumption; your BG should remain below 140 mg/dl; between 140 and 199 is "prediabetes", and over 200 is diabetes.
    So.. while your HbA1c seems to indicate some level of insulin insensitivity, it's not at the diagnostic level yet, and is an inappropriate measure for your circumstance anyway. All the rest of the details you've offered (about your weight, family history, and ethnicity) are statistical indicators - NOT actual tests of whether or not your system is insensitive to insulin. If it is, you may eventually develop the weight issues you reference. Better to have a proper test done, and start watching your carb consumption and maintaining your activity level - it's better for everyone whether they're D or not!
    Good Luck!

    w.

  3. ForecasterJason

    T1wayne:
    Hi Jason - welcome to the "club" no one wants to join. Even if you wind up not really joining! According to the WHO, the HbA1c test (correctly termed the Haemoglobin Subtype A1c measure) should NOT be used to diagnose "young people" - persons below 25 yrs of age. When it is used, it should be done TWICE, on separate occaisions. A measure at or above 6.5% is indicative of diabetes. Non-D range for the HbA1c is 3.5% to 5.5%, so your 5.7% is barely above normal, and a fasting BG of under 100 mg/dl is in the normal range. So while you may be trending toward D, you are by no means there. Also... even if your doc or anyone else has told you the HbA1c is a measure of your "average blood sugar" over the past 90 days, it's NOT... it's a measure of the percentage of your red blood cells that have glycosylated (bound with sugar molecules) over the past 90 days, and from that an ESTIMATED average blood sugar can be INFERRED, but it's based on large population studies, and your personal "average" may be different.
    The real issue for "prediabetics" is insulin insensitivity - the underlying cause of T2 (type 2 D). To test for this more definitively, the OGTT (Oral Glucose Tolerance Test) is used. In this test, you go to the lab or docs office fasting, they test your BG (it should be under 100 mg/dl) and they feed you 75 g of anhydrous glucose (a really sickly sweet concoction of sugar), then test your BG at 1 and 2 hours after consumption; your BG should remain below 140 mg/dl; between 140 and 199 is "prediabetes", and over 200 is diabetes.
    So.. while your HbA1c seems to indicate some level of insulin insensitivity, it's not at the diagnostic level yet, and is an inappropriate measure for your circumstance anyway. All the rest of the details you've offered (about your weight, family history, and ethnicity) are statistical indicators - NOT actual tests of whether or not your system is insensitive to insulin. If it is, you may eventually develop the weight issues you reference. Better to have a proper test done, and start watching your carb consumption and maintaining your activity level - it's better for everyone whether they're D or not!
    Good Luck!

    w.
    Thanks, Wayne. I didn't know that the A1c wasn't designed to be used on young adults. My doctor just wanted me to get my levels retested in a year, so I probably won't get the OGTT done (unless my glucose levels are worse then.)
    What I still don't understand though is how it's possible to be insulin resistant and not have a buildup of at least some fat (unless it just takes that much time in some cases.) Again, from my understanding (as this source explains) is that people who are very insulin sensitive store are able to store excess glucose as glycogen in the liver and muscles (which seems to be what's going on in my case), while insulin resistant people store the glucose as triglycerides. I think it's worth noting that in my case, while I never had my A1c level tested before last month, my overall lipid and metabolic profile has not changed much in the past 2-3 years. I had blood work done in January 2013, and back then I still had very low triglycerides and good HDL/LDL levels. My fructosamine was at 1.9, although I've seen different ranges given so I'm not sure how relevant that is.
    I will admit, I've always had generous amounts of carbs in my diet. With my increased activity level I'm expending about 2500-2600 calories a day (I have a Fitbit.) I've seen recommendations all over the place for macro splits. My general diet works out to around 50% carbs, 30-35% fat, and 15-20% For individuals who are physically active, I've seen recommendations for even higher carb percentages (although that's not taking diabetes into account.) Even at 2400 calories (which is still a little less than what I'm burning), that works out to 300g of carbs, 100g of protein, and almost 90g of fat. The number of carbs seems rather high to me, but considering my size too much more protein would likely be a waste, and more fat would probably aggrevate mild digestive issues I have.

    Do you agree that this is a reasonable way to go? I'm just cautious about trying to be more aggressive and trying to keep carbs low (which like I mentioned in my case would lead to unnecessarily high protein or fat intake). Considering how much energy I'm expending due to my age and energy level, I'm hesistant to make major changes. And from a satiety perspective, it would probably be difficult for me to even get at least 2400 calories with a substantially higher protein or fat intake.

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