T1 and Oral Surgery



J

James

Guest
I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery (wisdom
teeth out) next month. I have never been put under anesthesia, and am more than a little concerned
about how my body will react and what will happen to my blood sugar while I am asleep. Since I am
guaranteed to not wake up if I get low, I am thinking about taking a low basal dose or none at all
on the day of the surgery. Thoughts/advice on dealing with surgery from those taking insulin? TIA.
 
A

Alan Mackenzie

Guest
James <[email protected]> wrote on Fri, 6 Feb 2004 02:47:04 -0700:
> I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery
> (wisdom teeth out) next month.

Ah! You mean, you're going to the dentist! Got you!

As a matter of interest, how long have you been T1?

I'm a 46 y.o. T1, and spent time (a lot of it) at the dentist last year getting lots of crowns
fitted. It was all done with local anaesthetics, though. No particular problems, there.

> I have never been put under anesthesia, and am more than a little concerned about how my body will
> react and what will happen to my blood sugar while I am asleep.

I've had a general anaesthetic just once, when my knee was getting seen to after a skiing accident.
But the surgeon and his team knew all about my diabetes. I'd had no insulin and no food on the
morning of the op.
:-( Somehow, when I woke up a fraction of a second later (subjective
time), my BS was merely very high, not at danger levels.

> Since I am guaranteed to not wake up if I get low, ....

How so? I went low to the point of unconciousness quite a few times in the distant past. I always
woke up again. At a certain point, the liver kicks in with a glucose dump. Leaves you feeling
rotten, but alive.

> .... I am thinking about taking a low basal dose or none at all on the day of the surgery.

I wouldn't omit your basal dose. Do you really want to end up in the emergency ward with DKA? But
reducing it might be an idea. Or alternatively, increase it, more or less eliminating the Novolog.
Trouble is, Lantus is quirky stuff, building up its action over days rather than responding
immediately to changes.

> Thoughts/advice on dealing with surgery from those taking insulin?

Don't panic! Eat well the day before, so you won't go hungry! And don't even bother trying to keep
within 80-120. 120-250 is a more sensible target.

How long are you going to be unconscious for?

What does your dentist say? Is he helpful or dismissive? What does your DM specialist say?

And take some aspirins with you, to control the pain in your mouth afterwards (but make sure they're
OK to use).

--
Alan Mackenzie (Munich, Germany) Email: [email protected]; to decode, wherever there is a repeated
letter (like "aa"), remove half of them (leaving, say, "a").
 
G

Guy

Guest
On Fri, 6 Feb 2004 14:07:36 +0000, Alan
Mackenzie<[email protected]d> wrote:

>James <[email protected]> wrote on Fri, 6 Feb 2004 02:47:04 -0700:
>> I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery
>> (wisdom teeth out) next month.

I have had quite a few dental procedures in the past years without any real problems. In the past
year I had to have surgery to remove the root of a crowned tooth when the crown post failed. No real
problem. With diabetes, I am very careful with blood sugar before and after. My dentist places me on
antibiotics in the post surgery period. The other issues are the same as a non diabetic..

There is the thought that infection in the oral area may make diabetes harder to manage. I know of
several cases where attention to infections did help. It may involve removal of teeth..

MY real pain is when I pay. On one procedure the price has tripled in the past five years. Guy
 
R

Randy Sigman

Guest
In misc.health.diabetes James <[email protected]> wrote:
> I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery
> (wisdom teeth out) next month. I have never been put under anesthesia, and am more than a little
> concerned about how my body will react and what will happen to my blood sugar while I am asleep.
> Since I am guaranteed to not wake up if I get low, I am thinking about taking a low basal dose or
> none at all on the day of the surgery. Thoughts/advice on dealing with surgery from those taking
> insulin? TIA.

I had the same set of circumstances about 25 years ago, except my insulin then was NPH. My doc
suggested a reduction in my morning shot, if I recall correctly. This is something you really should
discuss with your endo. Typically, this type of surgery has you awake within an hour or so, so the
dangers are very small. If the oral surgeon permits it, you might want to suck on some hard candies
in the morning just to be on the safe side.

Best of luck,

Randy
 
B

Bj

Guest
"Alan Mackenzie" <[email protected]> wrote in message
news:[email protected]...
>
> And take some aspirins with you, to control the pain in your mouth
afterwards (but make sure they're OK to use).
>
> --

You should NOT take aspirin in the days before or right after surgery! It can lead to
extra bleeding.

There are other pain medications available, and you should be able to get a prescription for some
from your dentist or doctor, as well as instructions on what types of otc meds you can safely take
for the duration. bj
 
M

Mack

Guest
On Fri, 6 Feb 2004 14:07:36 +0000, Alan
Mackenzie<[email protected]> wrote:

>James <[email protected]> wrote on Fri, 6 Feb 2004 02:47:04 -0700:
>> I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery
>> (wisdom teeth out) next month.
>
>Ah! You mean, you're going to the dentist! Got you!

an oral surgeon is not a dentist.

Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org

In tribute to the United States of America and the State of Israel, two bastions of strength in a
world filled with strife and terrorism.
>
>As a matter of interest, how long have you been T1?
>
>I'm a 46 y.o. T1, and spent time (a lot of it) at the dentist last year getting lots of crowns
>fitted. It was all done with local anaesthetics, though. No particular problems, there.
>
>> I have never been put under anesthesia, and am more than a little concerned about how my body
>> will react and what will happen to my blood sugar while I am asleep.
>
>I've had a general anaesthetic just once, when my knee was getting seen to after a skiing accident.
>But the surgeon and his team knew all about my diabetes. I'd had no insulin and no food on the
>morning of the op.
>:-( Somehow, when I woke up a fraction of a second later (subjective
>time), my BS was merely very high, not at danger levels.
>
>> Since I am guaranteed to not wake up if I get low, ....
>
>How so? I went low to the point of unconciousness quite a few times in the distant past. I always
>woke up again. At a certain point, the liver kicks in with a glucose dump. Leaves you feeling
>rotten, but alive.
>
>> .... I am thinking about taking a low basal dose or none at all on the day of the surgery.
>
>I wouldn't omit your basal dose. Do you really want to end up in the emergency ward with DKA? But
>reducing it might be an idea. Or alternatively, increase it, more or less eliminating the Novolog.
>Trouble is, Lantus is quirky stuff, building up its action over days rather than responding
>immediately to changes.
>
>> Thoughts/advice on dealing with surgery from those taking insulin?
>
>Don't panic! Eat well the day before, so you won't go hungry! And don't even bother trying to keep
>within 80-120. 120-250 is a more sensible target.
>
>How long are you going to be unconscious for?
>
>What does your dentist say? Is he helpful or dismissive? What does your DM specialist say?
>
>And take some aspirins with you, to control the pain in your mouth afterwards (but make sure
>they're OK to use).
 
P

Philip Smith

Guest
Mack wrote:
> On Fri, 6 Feb 2004 14:07:36 +0000, Alan Mackenzie<[email protected]> wrote:
>
>
>>James <[email protected]> wrote on Fri, 6 Feb 2004 02:47:04 -0700:
>>
>>>I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery
>>>(wisdom teeth out) next month.
>>
>>Ah! You mean, you're going to the dentist! Got you!
>
>
> an oral surgeon is not a dentist.
>
> Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org
>

Here in the UK an oral surgeon is qualified in both dentistry and medicine - that means being a
student for about ten years! A lot of the work they do used to be patching up faces that hit car
windscreens, but I suppose that has been reduced by seat belts. One I know used to play the guitar
(when she had some free time!). Philip
 
D

Doug

Guest
Best not to get confused between dental surgeons (dentists) and maxillo-facial surgeons. Dental
surgeons would usually deal with the teeth issues (including wisdom teeth extractions) and m-f
surgeons with the facial reconstruction type of work. It is true that in the UK dentists are members
of the Royal College of Surgeons and are, tecnically, surgeons rather than doctors.

Doug "Philip Smith" <[email protected]> wrote in message
news:[email protected]...
> Mack wrote:
> > On Fri, 6 Feb 2004 14:07:36 +0000, Alan Mackenzie<[email protected]> wrote:
> >
> >
> >>James <[email protected]> wrote on Fri, 6 Feb 2004 02:47:04 -0700:
> >>
> >>>I am a 30 year old Type 1 and I currently take Lantus and Novolog. I am having oral surgery
> >>>(wisdom teeth out) next month.
> >>
> >>Ah! You mean, you're going to the dentist! Got you!
> >
> >
> > an oral surgeon is not a dentist.
> >
> > Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org
> >
>
> Here in the UK an oral surgeon is qualified in both dentistry and medicine - that means being a
> student for about ten years! A lot of the work they do used to be patching up faces that hit car
> windscreens, but I suppose that has been reduced by seat belts. One I know used to play the guitar
> (when she had some free time!). Philip