Management of Diabetic patient in a dental clinic

• What is Normal Blood glucose level- Fasting:60-110mg/dl of blood     Postprandial (after 2 hr. of taking main course meal) : 90-140mg/dl of blood
• What happens in diabetes- Fasting: >126mg/dl   postprandial : >200mg/dl
• Complications-

1. Hypoglycemic shock (when blood glucose level goes below 60mg/dl)
2. Hyperglycemic coma(Ketotic/nonketotic)( Ketotic coma: >600mg/dl  Nonketotic coma:<600mg/dl)
3. Delayed wound healing
4. Increased chances of infection

• Management of a diabetic patient whose blood sugar is under control-

1. Patient whose diabetes is under control doesn't need any specific preoperative precaution.
2. Patient should be given an early morning appointment.
3. Ask patient to come to the dental clinic after having breakfast,at least 2 hr before the visit.Also make sure that patient doesn't miss his oral anti diabetic drug regime.
4. Before starting any treatment postprandial glucose level should be measured.It should be under normal range.
5. If possible during and after the end of treatment,also measure the blood glucose level.
6. If your patient is too much anxious regarding dental surgery,than you can prescribe a dose of diazepam for at least 3 to 4 days before surgery.If patient is becoming anxious during the process of dental surgery,just stop the process there and ask patient to relax.
7. At the time of stress catecholamines (norepinephrine is augmented mostly during surgery and epinephrine postoperatively) stimulate gluconeogenesis and glycogenolysis, inhibit glucose utilization by peripheral tissues, and inhibit insulin secretion. Therefore its must too control stress in a diabetic patient.Stress is common due to fear of surgery.
8. Try not to keep appointment for a long time.
9. Give proper antibiotic coverage along with ethamsylate,to allow proper healing in future.

• Management of a diabetic patient whose blood sugar is not under control-(>200mg/dl)

1. Only emergencies should be treated.
2. Ask patient to stop his oral anti diabetic drug one day before the day of surgery.Keep patient on fast before the day of surgery and ask him to come empty stomach for surgery.
3. Measure the blood glucose level before the commencements of surgery.Also monitor sugar during the procedure.
4. For minor surgery, perioperative hyperglycemia (>200 mg/dl) can be managed with small subcutaneous doses (4–10 units) of short-acting insulin.
5.  For major surgery,intravenous insulin,with glucose & potassium chloride,should be administered.(Table1)
6. After the end of surgery,normal drug regime can be started.
7. Diazepam,antibiotics and ethmsylate to be used same as above.
8. In case of minor surgery its must to avoid hypoglycemia.

*  1 IU is the biological equivalent of about 45.5  pure crystalline insulin (1/22 mg exactly).