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Drilling for Blood Glucose
October 11, 2007
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.
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!
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