When it comes to oral surgery, people with diabetes need to take special precautions. Diabetes can cause infections and delay wound healing, so it's important for dentists to be aware of the risks and take the necessary steps to ensure the safety of their patients. Depending on the dental procedure, antibiotics may be necessary. If the treatment disrupts the patient's normal diet, the dentist should consult with their doctor about adjusting their insulin and antidiabetic medications.
Salicylates can increase insulin secretion and sensitivity, so diabetic patients should not use compounds containing aspirin. It's important to maintain glycemic and metabolic control during surgery, so preoperative evaluation should include a careful evaluation of any heart or kidney disease. Self-monitoring of glucose levels is important in the week before surgery in order to adjust insulin regimens as needed. Oral drugs and long-acting insulin are usually discontinued before surgery, although glargine can be administered to cover basal insulin throughout the surgical period.
Variable scale subcutaneous insulin regimens may not be ideal because they can cause erratic blood glucose levels. Intravenous insulin infusion offers more predictable absorption rates and allows for quick adjustments to maintain adequate glycemic control. Insulin is usually infused at a dose of 1-2 U per hour and adjusted according to blood glucose checks. A separate dextrose infusion prevents hypoglycemia, and potassium is generally added at doses of 10-20 mEq per liter in patients with normal renal function and preoperative serum potassium levels.
Frequent monitoring of electrolytes and acid-base status is important during the perioperative period, especially in patients with type 1 diabetes, as ketoacidosis can develop at moderate levels of hyperglycemia. Scheduling surgery early in the morning can help reduce fasting-related blood sugar problems. Diabetic ketoacidosis and hyperosmolar hyperglycemic status are unlikely to occur as acute emergencies in the dental office. However, many patients with diabetes who require emergency surgery may not have good metabolic control at that time and may even have diabetic ketoacidosis.
It's important for dentists to recognize the impact of diabetes on dental care. Patients should be instructed to carry their glucometers to every dental appointment on a routine basis. Most authorities recommend that patients with diabetes receive approximately 5 g of glucose per hour for baseline energy needs and to prevent hypoglycemia, ketosis, and protein degradation during surgery (Table 1). If a patient is taking one of these medications (sulphonylureas such as glyburide, glipizide or glimepiride, or meglitinides such as repaglinide or nateglinide), they should eat before dental treatment.