Advanced Education In General Dentistry

Patient Case: Diabetes Mellitus

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J.E. is a 34 year old woman with IDDM referred by her general dentist for extraction of her wisdom teeth. The patient has had several episodes of peri-coronitis and now wishes to have the teeth extracted while sedated.

PMHx: IDDM for 10 years, Peripheral neuropathy, Retinopathy
PSHx: Laser Eye Surgery
Medications: Insulin
Allergies: No known drug allergies

Questions For The Patient

  1. How well controlled is your blood sugar? What is your average?
  2. Have you had a hemoglobin A1c level mesured lately? If so, what was the result?
  3. What is your regular insulin regimen?
  4. Ask questions about the co-morbid diseases that are common among diabetics. Including: PVD, MI, HTN, Retinopathy, Renal dysfunction, CAD, Neuropathy.

Implications For Sedation

There are several issues to consider when sedating a patient with IDDM. Perhaps the most important is the management of the patient's blood glucose. Prior to sedation the patient must be NPO for the preceeding 8 hours. If the patient were to take their regular dose of insulin theyn they would likely become hypoglycemic and possibly go into shock. To avoid this the patient needs to adjust their insulin regimen on the day of the procedure. Patients with diabetes are also prone to cardiovascular disease, peripheral neuropathy, retinopathy, peripheral vascular disease, hypertension, renal failure and impaired immune function. It is therefore important to inquire about these diseases and also be aware of how sedation may affect the patient. Please note that patients with poorly controlled diabetes should not be considered for sedation.

Summary Of Treatment

  1. Insulin Dose on morning of procedure: No regular, 1/2 NPH dose
  2. Check FSG prior and after procedure
  3. Morning appointment
  4. IV fluid with 5% dextrose
  5. Administer D50 if severely hypoglycemic
  6. Ensure ability to take liquids by mouth before discharge
  7. Supplemental Oxygen
  8. Vitals monitoring

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