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As diabetes educators, we are aware of the correlation between diabetes and dental disease, but we need to bring this to the attention of our patients more frequently. Oral care is especially important for maintaining healthy teeth and gums. Tooth decay and gum disease occur when bacteria in the mouth mix with the sugars and starches in the food eaten to form placque. the placque clings to the surface of the teeth and gum line causing red, tender and bleeding gums, tooth decay and dissolving toot enamel. If it is not removed by brushing and flossing, the placque, which is a gummy film made up of bits of food, saliva and bacteria, then turns to tartar which can oly be removed professionaly.
Bacteria in the mouth thrive on sugar, inviting the growth of bacteria that cause dental diseases such as gingivitis, periodontal disease and even tooth loss, making it more difficult to control blood glucose. Periodontal disease is associated with the development of type 2 diabetes.
Patients should be encouraged to brush after meals and especially at bed time or as least rinse, even after snacking between meals. A sof bristle brush with rounded edges should be used to provide gentle brushing, which should include the tongue. Flossing at least once a day helps to rid placque at the gum line and remove food from hidden places that a brush cannot reach. Dental appliances should be removed and brushed or rinsed once daily as well. Patients should be encouraged to see their dentist for checkups once every 6 months and reminded to tell the dentist that they have diabetes. However, often dentists can suspect diabetes in an undiagnosed patient by detecting a sweet smelling breath or dry mouth and can predict how well the patient’s blood glucose is controlled.
Dry mouth occurs when there is an insufficient amount of saliva to keep the mouth moist. Saliva aids in digestion and helps to prevent infection by washing bacteria from the mouth as well as dead skin cells that accumulate on the gums, tongue and cheek. Dry mouth can also alter taste. Saliva moistens and irrigates the mouth by neutralizing acids that are produced by the placque. Smokers, mouth breathers and those on dialysis are candidates to develop dry mouth.
Food choices and eating habits can help or hinder the health of the mouth. Foods that help to build strong muscles, bones and a healthy body also help the gums and teeth to be healthy. Dairy products for Vit D and phosphorous, breads and cereals for Vit B and iron, fruits and vegetables for Vit C and folic acid and lean meats and poultry that provide iron, protein, magnesium and zinc, all help to protect against gum and tooth disease. Cheese, sugar free gum and peanuts help to increase saliva, thus decreasing the formation of plaque.
The side effects of some medications can cause dry mouth, especially those used to treat heart problems and hypertension. Other culprits are those used for anxiety, sedatives, diuretics, depression, muscle relaxants, anti-psychotics and anitinflammatory conditions. Patients should avoid caffeinated beverages, foods and liquids that have a high sugar or salt content, diet sodas and citrus juices. Adequate amounts of water should be encouraged to irrigate the mouth and prevent dehydration. A lip balm is also recommended.
Good oral hygeine is important in maintaining healthy gums and teeth and can help control hyperglycemia and should be consistently brought to the attention of our patients with diabetes.
Submitted by Annette Karnash

Data continues to accumulate that abnormalities of the immune system may play a fundamental role in the development of the immune attack on beta cells and the subsequent development of type 1 diabetes. The gut-immune system serves a vital role in processing the many food and microbial antigens, particles that elicit the formation of antibodies by WBC’s to protect the body from infection or allergy. In some cases, the gut-immune system develops antibodies that ultimately attack the beta cells. Interestingly, one of the contributing factors to type 1 diabetes may be poor protein digestion.
In animals, diet can modify the development of autoimmune diabetes. Diets containing partially digested protein produce a lower rate of autoimmune diabetes than diets containing whole protein, because whole proteins are more likely to result in the formation of antibodies against them. In humans, 2 proteins with the higher degree of incrimination are found in milk (Bovine serum albumen as well as Bovine I) and wheat (gluten). Dietary born insulin differs from human I by only three amino acids– the building blocks of protein. If an individual develops antibodies to Bovine I, there is a good chance that these antibodies will also attack their own insulin. In addition to causing antibody mediated destruction of the beta cells, Bovine I can activate T-cells in those predisposed to diabetes in a manner that can lead to beta cell destruction by direct attack by specialized T-cells known as T-killer cells.
There is strong evidence implicating dietary factors such as cow’s milk and gluten as importatn triggers of the autoimmune process that leads to type 1 diabetes. In contrast, breast feeding has been identified as an important factor in establishing proper gut immune function and reducing type 1 risk. Breast feeding reduces the risk of food allergies and protein against bacterial and viral intestinal infections. Early exposure to cow’s milk may increase the risk by 15 times.
There is also considerable evidence that sensitivity to gluten- the major protein component of wheat, rye and barley- may also play a role. Gluten sensitivity produces Celiac Disease, associated with damaged small intestinal structure caused by the immune system’s abnormal response to gluten. Breast feeding appears to help prevent Celiac Disease while early introduction to cow’s milk is believed to be a major causative factor. The risk of developing type 1 diabetes is higher in children with Celiac Disease. Celiac Disease, like type 1 diabetes, is assoicated with gut-immune function abnormalities, omega-3 fatty acid deficiencies and nitrates. More information on the subject can be found in the following:
Vaarla,O. The GUT-IMMUNE SYSTEM and TYPE 1 DIABETES.N.Y
Academy of Science.2002;958: 39-46
Submitted by Annette Karnash

The likelihood of developing type 2 diabetes is largely a function of what we eat, how much we exercise and most importantly, how much we weigh. More than 60% of the diabetic cases can be attributed to overweight*. (*BMI of 25-29) But losing weight can reduce the risk of diabetes and current weight has a greater impact on the risk of diabetes than previous weight. If weight is lost and kept off, risk is substantially lower. This can be achieved with physical activity. Even modest activity provides some benefit, such as walking 3 hours a week. Obviously, the faster and more frequently the exercise, the faster the weight loss. Diet is of prime importance to diabetic management. Three factors that influence diabetes are fiber, fat and glycemic index.
Fiber- slows the conversion of high glycemic index foods into glucose during digestion, thereby avoiding spikes in blood sugar levels. This in turn decreases the demand for insulin, which lowers the risk of diabetes. Foods rich in cereal fibers are bran, barley, oatmeal and whole wheat bread.
Fat- the consumption of total fat, saturated fat, non mono-unsaturated fat affected the risk of diabetes, but trans fatty acids (vegetable fats that are solid at room temperature and listed on food labels as ‘partially hydrogenated vegetable oils’) increase the risk. These are found in margarines, shortening, french fries and commercially baked products. Polyunsaturated fats (primarily from plant foods and fish sources are liquid at room temperature) reduced the risk of diabetes. These are liquid vegetable oil, oil based salad dressings, tuna and salmon.
Glycemic Index- A food with a high glycemic index can increase blood sugar rapidly, forcing the production of large amounts of insulin to counteract the glucose level. Over time, this increase in insulin production can cause diabetes. High glycemic index foods are white breads, baked potato; while low glycemic index foods are apples, beans and whole grain pastas.
Diabetes can be prevented with weight control, physical activity and a healthy diet. Women can lower their risk by 90% even with a family history of diabetes. Taking these steps is an important part of a healthy life style that helps to not only lower the risk of diabetes, but also of heart disease, cancer, stroke, arthritis and osteoporosis.
Annette Karnash
BMI-
Healthy Weight 18.5-24.9
OVerweight and at risk 25-29.9
Obese and at risk Over 30