Oral surgery can be complicated by poorly controlled diabetes. Diabetes slows healing and increases your risk of infection.

Your blood glucose may be more difficult to control after oral surgery. The blood glucose levels may swing widely due to the added stress of the surgery and your inability to eat properly after the surgery due to discomfort.

The key is to keep your blood glucose levels under control before you even consider oral surgery. A trip to your doctor before you for surgery is vital. You dentist or oral surgeon may want to communicate with each other. You may need to take an antibiotic before any procedures.

Unless your doctor orders otherwise - eat before your dental visit and take your usual medications. Check your blood glucose to be sure it is in the normal range. If it is too high your surgery may need to be postponed.

If you expect your oral surgery or dentist visit to leave your mouth sore, then plan ahead and have soft or liquid food available to eat when you get home.

If your blood sugar is poorly controlled and your dental needs are urgent (or an emergency), you may need to receive your dental procedures in the hospital or same day surgery facility. This may allow them to monitor you more closely as you recover from the procedure.

After the dental procedure, take care to prevent further problems.

1. Brush your teeth after every meal and snack with a soft toothbrush.

2. Floss your teeth at least once a day.

3. See your dentist at least twice a year (or as directed by your dentist).

Diet alone is designed to provide the diabetic patient with calorie, support normal growth in young people with diabetes and bring the weight of the obese diabetic patient down to the correct level. A balanced diabetes diet with high fiber content and the food being digested and absorbed slowly is necessary for people with diabetes.

Highlighting diabetes diet further, foods that are being consumed by man contain one or more of the six classes of food which are; carbohydrates, protein, fat, vitamins, minerals and water. Each of these food classes has vital role to play in the normal functioning of the body system. After thorough study of diabetes diet, some classes of food were found to be helpful while others can worsen a diabetic state.

Two vital symptoms implicated in diabetes are overweight and excess sugar. Based on this, it became apparent that for good diabetic diet, avoidance of certain food becomes necessary. It could also be the only requirement for prevention or control of diabetes. Any food that can make one become fat or one with high energy content should be excluded from diabetes diet.

A word of caution to everyone is this: In managing diabetes diet, bear in mind that high sugar foods are more concentrated in carbohydrates. High sugar foods are always tempting to eat, so it is recommended that you go for low sugar foods. That is diabetes diet for you.

Please don’t deceive yourself by feeling free to consume so much food just because there is no taste of sugar. Your diabetes diet meal plan is designed in a way that the carbohydrate contents of your food remain as consistent as possible. Strict adherence to your diabetes diet aids in controlling diabetes.

Oral hypoglycemic Agents: They work by making the pancreases of a diabetic patient secrete more insulin thereby lowering the blood sugar level in the blood. Thus there should be residual pancreatic activity. Pancreatic activities include reduced hepatic release of glucose and increased sensitivity to insulin.

Side effects include fever, jaundice, photosensitivity, headaches.

Insulin: Insulin is a polypeptide hormone which is usually extracted from beef or pork pancreas and purified by crystallization. It can also be made biosynthetically by recombinant DNA technology. It is easily digested by the GIT enzyme hence its parenteral use. It may be given in the abdomen, arm and thigh with their absorption in that order. It could come as rapid onset short acting, intermediate acting or delayed onset long acting insulin. Patients requiring very large doses of insulin should receive two or more injections of soluble insulin daily.

Complications of insulin include unusually low level of blood sugar in the blood, a localized shrinkage and loss of fat under the skin, presence of microorganisms in tissue etc. Complications of diabetes requiring expert management include diabetic retinopathy (a disease of the retina), nephropathy (a disease or medical disorder of the kidney), diabetic foot etc.

Lysophosphatidylcholine (Lyso-PC), a major phospholipid component of atherogenic lipoproteins, is increased in patients with Type 2 diabetes, researchers report.

This rise in Lyso-PC is linked to increased activity of lipoprotein-associated phospholipase A₂ (Lp-PLA₂) and suppression of the antioxidative enzymes paraoxonase and homocysteine thiolactonase (HTLase).

Increased oxidative stress plays a key role in the pathogenesis of atherosclerosis.

Masanori Iwase (Kyushu University, Fukuoka, Japan) and co-workers investigated the relationship between Lp-PLA₂, antioxidative enzymes, and production of Lyso-PC in 96 patients with Type 2 diabetes and 25 healthy controls recruited at a university hospital in Japan.

Levels of Lyso-PC and activity of HTLase, paraoxonase, and Lp-PLA₂ were measured.

Writing in the journal Diabetes Research and Clinical Practice, the authors report that serum HTLase and paraoxonase activities were significantly suppressed in patients with diabetes compared with controls, whereas activity of serum Lp-PLA₂ did not differ between the two groups.

They also confirmed findings from previous studies that Lyso-PC content of circulating low-density lipoprotein (LDL) is significantly higher in patients with Type 2 diabetes compared with controls.

Lyso-PC correlated positively with serum Lp-PLA₂ activity and negatively with serum HTLase activity. The activity of both enzymes independently contributed to Lyso-PC content in LDL.

The authors also investigated Lyso-PC content in LDL and serum Lp-PLA₂, HTLase and paraoxonase activities in relation to different clinical stages of diabetic nephropathy.

They found that as nephropathy progressed, there was a significant increase in Lyso-PC content in LDL compared with control. Serum HTLase and paraoxonase activities were significantly reduced in patients with micro- or macroalbuminuria compared with control, whereas serum Lp-PLA₂ activity was not significantly different from control in any stage of diabetic nephropathy.

When patients were treated with simvastatin for 3 months, there was a significant reduction in both serum Lp-PLA₂ activity and Lyso-PC content in LDL with no effect on serum HTLase activity.

“These findings suggest that serum Lp-PLA₂ and HTLase activities may be related to Lyso-PC contents in LDL in Type 2 diabetic patients,” write the authors.

It remains to be determined whether Lyso-PC in LDL is suppressed by the enhancement of paraoxonase and HTLase activity or by the action of Lp-PLA₂ inhibitors, which might be beneficial for the prevention of atherosclerosis in diabetic patients.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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