Drilling for Blood Glucose

This week, I’m taking a break from writing about my transition to the insulin pump so that I can discuss going to the dentist. Why? Because as someone relatively new to living with diabetes, I was confronted yesterday afternoon with yet another life-with-diabetes moment.

The background: Three weeks ago, I went in for my six-month teeth-cleaning—my first dental visit as a person with Type 1 diabetes. The cleaning went well, and I didn’t give too much thought to my blood glucose before that appointment. A dental visit doesn’t stress me out when it’s only a cleaning, and I made it through the thirty-minute appointment with little anxiety. At the end of my cleaning, however, the dentist came by to look at an old filling on number 15—a molar way back in the upper left-hand side of my mouth. She thought it would be a good idea to have it replaced.

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Yesterday, it was time. (Now, a dental visit doesn’t stress me out—when it’s only a cleaning.) After checking in, I checked my blood glucose: 126 mg/dl. Not bad normally, but here’s where I started to worry: Would my anxiety and possible fear and possible discomfort during the procedure cause my glucose to rise or to go low? I wasn’t sure, and my uncertainty didn’t help the situation.

The dental assistant leads me to the chair. I take a final swig of Gatorade Fierce (the purple stuff), thinking that it’s better to err on the side of higher blood glucose. The assistant says, “That stuff’s not very good for your teeth.” I want to say, “Yeah, but passing out from low blood glucose isn’t good for me, either.” Of course I don’t, but I do tell her I have Type 1 diabetes.

The dentist begins to drill out the filling. It’s soon apparent to her that the composite material will take some time to remove (but she doesn’t tell me until it’s over: “Wow, that took a long time to remove!”). As the drill’s whining away and eating into my tooth, I wonder “When is this going to end?” What’s worse, there isn’t any narration from the dentist (“Just a little more to go”; “We’re almost done”), and without those verbal cues the drill seems to go on forever, the wet tooth dust sparkling in the overhead lamp. I flash back to previous dentist visits (years ago, different dentists); I fear the anesthetic wearing off, the drill hitting a nerve.

I begin to fixate on my blood glucose. Is my stress and discomfort causing my glucose to rise, or is it taking a nosedive? I’m sweating, my legs feel weak, I’m clammy, and my stomach’s uneasy—all perfectly normal physiological reactions for me when someone’s drilling into my teeth. However, it’s also a normal physiological reaction for me when I’m experiencing a low blood glucose. So what do I do? I think about raising my hand to stop the drilling so I can check my blood glucose. But that will only prolong the discomfort. Am I overreacting? I try to think clearly: I just checked my levels about thirty minutes ago and then had some more carbs, so I should be fine.

Maybe. Maybe not. I just don’t know.

I don’t have a whale’s mouth, and this is tooth number 15, after all—way back there. My jaw aches from “open wider, please.” I close my eyes and take deep breaths. No, wait, I can’t do that—my hay fever’s acting up. I grip the armrests. I look up at the dentist in the hopes that I can see what’s going on in my mouth in the reflection of her glasses. Maybe that will help pass the time. Of course, I then worry that she might think it weird that I’m staring into her eyes (but of course I think that she’s probably not watching my eyes…isn’t she supposed to be watching my tooth?). I simply close my eyes and try again to relax.

When it’s all over, I get out my monitor and check: 136 mg/dl. Just fine, just fine.

I’ve found a few good resources that might have helped me yesterday. What dominates an online search for “diabetes” and “dentist” however, are articles on taking care of your teeth, rather than how to take care of your blood glucose during the actual exam. I now know that after breakfast is a good time to see the dentist—not in the afternoon, like I did. Midmorning, about 90 minutes after a meal, is when your blood glucose is closest to normal. And, like I did yesterday, you want to make sure your dentist can recognize the symptoms of hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose), and that you have an agreed-upon signal in case you need him or her to stop.

There’s also some great information on dental anxiety and diabetes and dental care in this Diabetes Self-Management article by Shirley Gutkowski, and I found this article by Miranda Schwartz that has some quick pointers for dealing with diabetes and your dental visit.

But for those of you who’ve been through this, tell me (so that I don’t feel so all alone): Has going to the dentist while having diabetes led to any problems for you? If so, what? If not, how do you prepare for an extended procedure? I’m curious about what gets you through your dental procedures!

  • tmc

    Stress typically raises my blood glucose levels and especially when I travel. Between traveling and eating in Resturaunts often while traveling I find myself with some pretty interesting blood sugar levels (200-300) before meals.

    At some point its hard for me to figure out how much extra insulin to take with out getting low. My Endo says all of this is normal and jut to get back into your routine when I return home.

  • Jan Chait

    The only major problem I’ve had regarding blood glucose at the dentist is when I was having a long procedure and started heading toward hypoglycemia. It happened that I had a can of SlimFast in the car, so we all took a break while I got my chocolate “fix” and bumped by BGs up. However, I do wish I’d had a straw in the car, too.

    I should point out that the incident was when I was taking two injections of Regular and NPH a day. Dealing with things on an insulin pump is a lot easier.

    So you belong to the insulin pumpers mail list? It’s an awesome resource if you’re a pumper. There’s a lot of information at http://www.insulin-pumpers.org, even if you don’t join the mail list but, with 5,000+ members, just about any question you have about pumping will get responses from people who have “been there, done that.”

  • dorisjdickson

    I only go to the dentist after work. Stress normally increases my adrenalin which increases my blood sugar. However, my dentist was a friend before he became my dentist and I trust him explicitly. He doesn’t let you see the novocaine. You don’t even feel it. He does not perform unnecessary procedures either. This trust reduces my stress.

    I target a blood sugar of 85 and test 15 times a day; so my biggest concern is if I have to go more than an hour without testing or if I know I need one of my split insulin doses after a meal (I do not take all my meal-time insulin in one dose).

    Yes, that not knowing is tough. Therefore, as I am chatting with the technician I pull my meter out, check and adjust. I also have at least one juice box with me at all times – more in the car.

    Oh, just a thought – for those of us who tend to have dawn phenomenenon, the most stable time of the day is not morning at all. It’s afternoon and early evening.

  • Eric L.

    Doris — Wow! Checking your bg 15 times a day! Does insurance have any qualms about that much bg monitoring a day, or did your doctor okay it?

    I’m supposed to do 10 checks/day, and lately have averaged around 8 or so (over the past 21 days, roughly). But now I’m pulling out strips at a faster rate because the past five days or so the bg has been higher. I think my pancreas, which has been on honeymoon the past six months or so, is starting to settle into diabetes life, letting the synthetic insulin do all the work. Lazy, no-good pancreas.

    Eric

  • johnUK

    Been reading this thread. I went to dentist other day for some root canal work. I am not,that I know of, diabetic .I had taken some paracetamol & codeine tablets 1/2 hr before. Dentist started injecting Novocaine and pretty much straightaway felt I was slipping away to somewhere. She immediately got cup of what she said was sugary water and made me drink it quickly. Within 1 minute was feeling normal again. She said it was hypoglycemia. Any ideas why this was, or was it maybe reaction to Codeine tablets ?.

    John

  • acampbell

    Hi krobinson,
    It sounds like your physician isn’t up to speed on how diabetes is diagnosed (blood glucose levels, not A1C levels, are used as diagnostic criteria). You can have diabetes and still have a “normal” A1C. Any kind of stress(including dental work) can raise BG levels. It’s unlikely that novocaine is affecting your BG. Other factors may be affecting your BG as well. Keeping a log of your BG levels, plus food and activity, can help sort things out. In the meantime, you might consider finding a physician who is more up to speed on diabetes.

  • krobinson

    I had a root canal done the last week of June 2007. My gums became very inflamed around the tooth. At that point,I was not diabetic. July 5, I became ill and by July 10 was diagnosed with diabetes. Two months later a different doctor told me I was not diabetic and that I had a normal A1C (5.9) She told me to return to eating normally and that I no longer needed to check my bg. Since then I have been ok. Until now. Last week I had a cavity filled. Today I got that drunk feeling and checked my bg and it was high. Could I be allergic to the novacaine? Why does it take a week to effect my bg? I am not ready to go thru 2 months of hell again or even worse, become dependent on insulin.

  • choctaw

    I am a type 2 diabetic. On a recent visit to my periodontal dentist, I received an injection to numb my gums for surgery. After the injection, my blood sugar level sent me into hypoglycemia and I had to have some apple sauce to bring up my blood sugar level before continuing. I have never had hypoglycemia before.

    My question is this: If this injection is effective in bringing down blood sugar levels, why couldn’t some type of use of this injection substance be useful in lowering blood sugar levels when they are running to high? This might be a stupid question, but I was just wondering. Thanks!

  • Cindy L. Yeager

    Today I went to the dentist for some major work. I checked my bg in the am before going and it was 115. I had 10 Novocaine shots over a 2 hour period. Didn’t check my BG. Had 3/4 cup mashed potatos and took 1 unit (by pump) 1 hour later my bg plumeted to 45. Was it the Novocaine affecting my bg??? I had no other explaination for it.

  • karen mikula

    Even though I’ve seen some posts claiming novacaine does not effect blood glucose levels. I beg to differ. I’ve had hypoglycemia for years, and I’ve always controlled in through diet. HOWEVER…I’ve had a root canal, tooth extraction, bone grafts, and failed implant surgery recently, and my experience is that novacaine containing epinephrine has a horrendous effect on me. It raises my insulin level immediately and leaves me with extremely low blood sugar levels several hours later. I asked my maxilofacial surgeon to use epinephrine-free novacaine on my last two procedures, and I was fine. If you are diabetic, request novacaine and anesthetics without epinephrine. They all have it!

  • Jon Hart

    Great reading and your description of the diabetics mind set is wonderful! You’re not alone in your quest for peace of mind. I too was searching for articles on the effects of anesthesia on BGLs, stumbled on this site. I’ve been elevated post some eye surgeries (A grim tale in itself, as the eye surgeries are like dental procedures on steroids). I had one two days ago and have been doing better than prior surgery’s. Up until today then it kind of jumped up in the 240 range. The anesthesiologist told me it would probably be elevated after my last surgery and it was. This time I had delayed reaction, over a day? But he told me not to chase it with insulin. It’s white knuckle stressful to me all the same.
    Like you just when I think I’m doing everything right with diet exercise and dosing, like it’s an exact science (A1C- 6.2) this hideous disease proves to me it’s a mysterious art form and bucks me on that pesky roller coaster ride. It leaves me thinking darn, is this meter broken or something? Not!
    All the calculations of carbs and sliding scale units, sometimes I feel OCD autistic, sigh!
    Hang in there!

  • Patti

    I’ve had insulin-dependent diabetes 2 for a year. Hypoglycemia consistently happens in the morning, never at any other time of day until today. I had a filling done after supper tonight. I ate beforehand. 3 hrs later I checked my bg (no symptoms) and I was 4.6. At the time the freezing was applied to my gum, I felt a bit shaky which has never happened to me before. It passed. Weird.

  • Christian Rivera

    I’ve been diagnosed with pre diabetes for sometime now and I’ve been trying to recover. Just this week I went to the Dentist to get a regular cleaning and after the cleaning I noticed that my blood sugar went really low… like 51 low. Since then I haven’t been the same, my dizziness as worsen and I feel more faint. I’m curious if going to the dentist had anything to do with my sugar levels. if anyone knows please let me know how you handled it. Im going to an Endo this monday because I need to get better.