Diabetes Mellitus and Oral Diseases
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- Brian L. Mealey, DDS, MS
Diabetic Emergencies in the Dental Office
The most common diabetic emergency in the dental office is hypoglycemia, a potentially life-threatening complication that must be managed accordingly. Signs and symptoms include confusion, sweating, tremors, agitation, anxiety, dizziness, tingling or numbness, and tachycardia. Severe hypoglycemia may result in seizures or loss of consciousness.
As soon as a patient experiences signs or symptoms of possible hypoglycemia, he or she should check the blood glucose with a glucometer. If a glucometer is unavailable, the condition should be treated presumptively as a hypoglycemic episode. The dental practitioner should give the patient approximately 15 g of oral carbohydrate in a form that will be absorbed rapidly.
If the patient is unable to take food by mouth and an intravenous line is in place, 25 to 50 mL of a 50% dextrose solution (D50) or 1 mg of glucagon can be given intravenously.
If an intravenous line is not in place, 1 mg of glucagon can be injected subcutaneously or intramuscularly at almost any body site. Glucagon injection causes rapid glycogenolysis in the liver, releasing stored glycogen and rapidly elevating blood glucose. Following treatment, the signs and symptoms of hypoglycemia should resolve in 10 to 15 minutes. The patient should be observed for 30 to 60 minutes after recovery. Evaluation by glucometer can ensure that normal blood glucose levels have been achieved before the patient is released.
In some instances, marked hyperglycemia may present with symptoms mimicking hypoglycemia. If a glucometer is not available, these symptoms must be treated as hypoglycemia. If the event was actually hyperglycemia, the small amount of extra glucose derived from treatment will generally not have a significant effect.
On the other hand, if glucose-elevating emergency treatment was withheld from a patient in a mistaken belief that the emergency was related to elevated glucose levels when hypoglycemia was in fact present, severe adverse outcomes are possible. The best means of determining the true nature of a glucose-related emergency is to check the blood glucose level with a glucometer.
Because hyperglycemic emergencies develop more slowly than does hypoglycemia, they are less likely to be encountered in the dental office. Diabetic ketoacidosis and hyperosmolar nonketotic acidosis require immediate medical evaluation and treatment. In the dental office, care is limited to activating the emergency medical system, opening the airway and administering oxygen, evaluating and supporting circulation, and monitoring vital signs. The patient should be transported to a hospital as soon as possible.
Conclusion
Diabetes mellitus is a metabolic condition affecting multiple organ systems. The oral cavity frequently undergoes changes that are related to the diabetic condition, and oral infections may adversely affect metabolic control of the diabetic state. The mechanisms underlie the oral effects of diabetes share many similarities with the mechanisms that are responsible for the classic diabetic complications. The intimate relationship between oral health and systemic health in individuals with diabetes suggests a need for increased interaction between the dental and medical professionals who are charged with the management of these patients. Oral health assessment and treatment should become as common as the eye, foot, and kidney evaluations that are routinely performed as part of preventive medical therapies. Dental professionals with a thorough understanding of current medical treatment regimens and the implications of diabetes on dental care are able to help their diabetic patients achieve and maintain the best possible oral health.
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