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Hypoglycemia
The most common acute diabetic emergency in the dental office is hypoglycemia. (27) Most diabetics begin to have symptoms when the blood glucose level falls below 70mg/dL. Persons with longstanding type 1 diabetes may have decreased ability to sense impending hypoglycemia. (48)
If left untreated these symptoms may progress to severe hypoglycemia, loss of consciousness leading to seizures and possible death. (19,27)
Prevention of hypoglycemia is best approached through patient education and self-monitoring of blood glucose levels. Documentation in the dental record regarding previous incidence of hypoglycemic episodes and current information regarding insulin/oral hypoglycemic agent therapy is also useful. After a hypoglycemic event occurs in the dental office, discussion of any precipitating factors may be helpful in preventing future episodes. Patient identification, such as an emergency medical bracelet, also helps to identify person as having diabetes.
Educating diabetics of the relationship between hypoglycemia and the risk factors for onset (see above list) can greatly reduce episodes of hypoglycemia. Patients may be aware of hypoglycemic symptomology before the dental professional. At this point, the diabetic individual may self-test for blood glucose level and/or eat something containing sugar. The dental professional should encourage diabetic patients to communicate changes in their condition that might signal onset of hypoglycemia.
If the individual is experiencing hypoglycemia they should consume 10 to15 grams of rapidly absorbable carbohydrates.
Repeated if necessary in fifteen minutes.
Symptoms may arise rapidly and it may become necessary for the dental professional to administer some form of oral carbohydrate (e.g., orange juice, and candy). If the patient is unconscious or unable to treat himself, the dentist can administer dextrose (50mL in 5% concentration) intravenously or Glucagon (see Appendix A) can be administered intramuscularly, intravenously or subcutaneously (See Table 5).
Table 5: Glucagon Dosage (19)
Children < 3 years of age (< 20 kg)
 |
0.5 mg.
|
Children  3 years of age and adults ( 20 kg) |
1.0 mg. |
At anytime during the episode when there is a rapid deterioration in the patient's status activation of the emergency alert system is necessary. Transportation to a hospital and consultation with the patient's physician is necessary. Patients experiencing hypoglycemia while taking hypoglycemic agents should be closely monitored at least 48 to 72 hours to prevent possible recurrence. (19,27,35,48)
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Hyperosmolar Syndrome
