What can we reasonably expect ....

[BlueSky]

... from a Dental Surgeon with regard to dealing with a T1 diabetic parient?

We recently had an experience that further weakened my confidence in the medical fraternity. And I would like to know what your thoughts on this are.

Our daughter Caroline, who is 19 years old and a T1 diabetic, had to have impacted wisdom teeth removed. She was refered by her Dentist to a Dental Surgeon, who by all accounts is competent and efficient. The procedure was done under sedation in his rooms and was successful. But Caroline didn't wake up afterwards as quickly as the dental surgeon expected. Based on her drowsiness, he thought that she must have low blood sugar. But he didn't have a blood glucose monitor to verify this. So he sent his nurse out to buy one from the pharmacy. And, to be on the safe side, he injected glucagon and called the ambulance.

By the time ambulance arrived, the nurse had returned and they were trying to get the newly acquired monitor to work. The paramedics used their meter, which read "HI", presumably because of the glucagon. They took her off to the emergency room anyway, where she was kept under observation until the next morning.

The boyfriend, who was there the whole time, related this story to me. As you can imagine, Caroline wasn't amused. In addition to having a sore jaw from the surgery, she also had a headache from the high blood sugar. And she had to spend a day in hospital. She is pretty sure that her blood sugar was in the target range when the glucagon was injected, and that the dental surgeon jumped to the wrong conclusion. But I guess we will never know exactly what happened.

I was dismayed to learn that medical professional would perform a surgical procedure on a T1 diabetic without having access to a blood glucose meter. Surely this is unprofessional. Or am I being unreasonable? What do you think?

[willow the elf]

The Dental Sergeon had to go to Med School. Did he know she was Type1 Diabetic when she went there?

[shockme]

hi bluesky!omg!i can't beleive that!he didn't have a meter?real good...that is scary-your poor daughter!you are not unreasonable!i would think it should be part of the equiptment!trish

[grace girl]

Unfortunatly, I can't say I'm suprised. Some of my experiences with doctors and nurses since my dx, and the "knowledge" they have about D absolutely scares me. I am sorry for what your daughter went through, sounds terrible.

[ladytaz]

I don't think you're being unreasonable at all!! He was obvioulsy notified BEFORE that she was a T1 (by his "thinking" that she might be low ...) Therefore, he SHOULD have been prepared in ADVANCE!

Having said that, not everyone wakes at the same rate, after being sedated! Different people react differently to anesthesia! (I know this just from over 20 years ago, when my son was sedated when he was about 2-1/2 for an "outpatient oral surgery" and they kept him in the hospital for hours afterwards for this exact reason!) He [the dentist] "should" also know this, and not have jumped to conclusions!! Had he been "prepared" and tested, he would have found that she was just probably one of those that react differently to the anesthesia, and awoke slower from it!

Amazing .... I've never been to med school, yet, I KNOW this!!!??? GAH! Everyday, I have less and less faith in the Medical Community!

People, when you find yoursleves a good doc, DO NOT let them go!! They are becoming FAR and FEW between these days!! I tell you what!!

I'm sorry ... this is just something that REALLY peeves me to NO end!!

I'm glad your daughter is doing well now, and SO sorry she had to go through all that UNneeded stuff!!

[notme]

I think there are a couple of things to consider here. The dental surgeon was out of his mind to do this proceedure without knowing what her blood sugar was doing. However, being diabetic, that would have been the first thing I would have asked. Who and what would be used to monitor my blood sugar? Your daughter is young. But, she will know now in the future what questions to ask if she ever needs to have any type of surgery again.
The dentist put himself at great risk for a law suit if something had happened to his patient. Your daughter put her life at risk for not asking the right questions.

Very scary stuff.

[BriOnH]

I think there are a couple of things to consider here. The dental surgeon was out of his mind to do this proceedure without knowing what her blood sugar was doing. However, being diabetic, that would have been the first thing I would have asked. Who and what would be used to monitor my blood sugar? Your daughter is young. But, she will know now in the future what questions to ask if she ever needs to have any type of surgery again.
The dentist put himself at great risk for a law suit if something had happened to his patient. Your daughter put her life at risk for not asking the right questions.

Very scary stuff.

Totally. I think the responsibility here for sure lies more on the doctor then the patient, but your daughter should have tested before becoming sedated. It's understandable she didn't, I mean after all she is with a doctor, but in the end the responsibility of our disease is our responsibility. It sucks but thats the hand we were dealt.

Lawfully, in the US, I believe the doctor would be held at fault. Hopefully your daughter learned from this experience as well.

[Diana]

Well, I think more discussion was needed prior to the surgery. I think your daughter and the surgeon should have been working together to look after her blood sugar. Did she test before the procedure? Did she even have her glucose meter with her? If so, I dont understand why hers couldnt have been used? If she didnt have it with her, well, I think that is very foolish! At least the doc did the right thing - no long term harm will be caused by giving glucagon to someone with a normal or high blood sugar, where the possible consequences of an untreated low blood sugar are much more serious.

If she was simply being put under sedation, and not under general anasthetic, I can understand that the doctor wasnt really expecting to have to monitor her blood glucose level during the procedure. As far as I understand, when under general anasthesia it is normally the anesthesiologist who takes care of these things, and not the actual surgeon.

I think in this case the doctor could have done a bit more to ensure that there was an understanding about who would be doing what in regards to your daughters diabetes, but I also thin that the doc generally did the right thing in the situation.

[JediSkipdogg]

Firstly, I don't think the doctor was underprepared at all. Why would a dental surgeon keep a blood glucose monitor in their office?

My question is, where was your daughter's blood glucose monitor is my question?

[Harold]

Sorry to here about your daughters experience BS. My parents were bad about going and having in/out surgery without letting anyone else know about it. As diabetics we cannot afford it, we need someone with us that knows to check before doing anything else. Yes, she should have had her meter with her or at least left it with her boyfriend just in case. The doctor should not have administered anything without knowing her condition either. Doctors are taught the it is better to error on the side of high bg's rather than on the low side. My guess he did not ask, before or during, her boyfriend for her meter.

[Keezheekoni]

My question is, where was your daughter's blood glucose monitor is my question?
My thought exactly! Whenever I'm going to the dentist or oral surgeon, they know exactly how to check my bg with *my* monitor. They are taught how to use it (because it's on my pump), they are taught how to suspend my pump and they are shown where in my purse my liquid glucose and glucagon are.

I wouldn't ever expect anyone in the dental profession to have bg meters in their offices. Yes, they may have patients who are diabetic, but they should also be taught by each individual how we take care of ourselves. This is not a one-size-fits-all disease!

[JediSkipdogg]

My guess he did not ask, before or during, her boyfriend for her meter.

Personally, as I suspect, the boyfriend was just as bad as the other two. I see all three at an equal amount of fault here and I hope she dumped that boyfriend since he didn't seem to offer any assistance.

[shockme]

I wouldn't ever expect anyone in the dental profession to have bg meters in their offices. Yes, they may have patients who are diabetic, but they should also be taught by each individual how we take care of ourselves. This is not a one-size-fits-all disease!

not a plain dentist-but an oral surgeon,who frequently has patients under a general-yes-they should have a monitor.maybe i'm naive-ive onle been diabetic since jan-and [for once]haven't had any procedures done...trish

[Erin]

My question is why a Type 1 D would consent to being put under that much sedation in a doctor's office in the first place?! Sedation, fine, but to the point where she couldn't care for herself or communicate about her diabetes?? There is no way a oral surgeon can be expected to deal with the potential complications involved with an unconscious diabetic.

He did EXACTLY what he should have given the situation, he thought she might be low, found himself unable to test, and he treated the low. If your daughter had indeed been low, he would have saved her life by taking those actions. If your daughter or her boyfriend had thought to make the glucometer available to this man, you would be singing his praises, not criticizing him.

I had my wisdom teeth out as well, and when the gas started making me feel too "out of it" I asked for it to be removed. Yes my jaw hurt, but there was no way I was going to be put in a dangerous situation... and my meter was in the room with me, and my mother was in the waiting room to assist, just in case.

[BlueSky]

Thanks for your comments. You all make good points. To clarify, Caroline didn't have her meter with her. She had left it at home. I am painfully aware that Caroline needs to be more responsible about her diabetes. But that is another story. There is a lot of history there. It is an ongoing drama and I can only hope and pray that there will eventually be a good outcome.

The Dental Surgeon obviously didn't know anything about the history. So, is the onus on the patient or on the doctor to ensure that the procedure will be successful. My feeling is that the doctor has to carry the can. And he should have been better prepared. Bear in mind that this is not an ordinary dentist. A Dental Surgeon is a medical specialist, who dentists refer their patients to for surgical procedres. So he really needs to be able to handle situations like this.

Anyway, all is well that ends that ends well. The upside to it is that Caroline hopefully learned something and will be more pro-active in the future. I think she is making progress. As parents we are having to back-off and have stopped rescuing Caroline when she gets herself into trouble. It seems to be working - she hasn't been in hospital with DKA for 9 months now. But progress is painfully slow!

[jen_slc]

I agree with the general feeling expressed here... I don't think the dental surgeon deserves all the blame. It would have been ideal, of course, for more discussion between him and your daughter prior to the procedure, so in this case both are at fault - she should have at least checked and had her meter with her, he should have at least asked her what her BG was. At the very least.

I had my 3 impacted wisdom teeth removed at about that age and my mom, regular dentist and I all decided together that I would have it done by a dental surgeon. I had an initial consult to discuss everything. Then I went back for the procedure. I had all my equipment, the surgeon met with us briefly to make sure my BG was ok and I was ready to go, then he put me under general anesthesia. I took a little bit to come out of it, but the actual surgery part just took 20 mins. Although I was nervous about "going under," I did feel very safe there and that I was in competent hands. It was good for the doc to check on my status beforehand, but essentially, it was mostly up to me to make sure I was good.

[Funnygrl]

I'm actually thankful it didn't happen the other way, like, she was low and he assumed it was just the anesthetic.

Generally speaking, one of the main things people are taught about hypoglycemia is that if you don't know the blood sugar, assume low.

I had an endoscopy recently, and was expecting the day center I went to for it to not have a meter. I brought my own with plans to test before and when I woke up. They did have a meter and tested me three times. I was pleasantly surprised.

[JediSkipdogg]

My question is why a Type 1 D would consent to being put under that much sedation in a doctor's office in the first place?! Sedation, fine, but to the point where she couldn't care for herself or communicate about her diabetes?? There is no way a oral surgeon can be expected to deal with the potential complications involved with an unconscious diabetic.

When you have your wisdom's out it is general practive to go fully under. The main reason is because you wouldn't make much sense anyways and if you moved your head at all and they hit a nerve, you're done. They came awfully close on me and the doctor said he could actually see the nerve, but never touched it. That caused my mouth to be puffed up alot longer than normal. He said if I was awake during it, it would have been freaking mad if he touched it and probably caused worst damage from moving. So essentially, it's a safety precaution in my opinion.

A Dental Surgeon is a medical specialist, who dentists refer their patients to for surgical procedres. So he really needs to be able to handle situations like this.

You said he's a DENTAL surgeon, not any other kind of surgeon. Keep in mind, dentistry is different than general hospital medicine. Therefore he's not going to have 10 weeks of diabetes in college and he may only see a handful of people a year with diabetes (or ones that at least say they are.) So he would need no more specialty in diabetes for treating a low than say a dermatologist.

[SueM]

... from a Dental Surgeon with regard to dealing with a T1 diabetic parient?

We recently had an experience that further weakened my confidence in the medical fraternity. And I would like to know what your thoughts on this are.

Our daughter Caroline, who is 19 years old and a T1 diabetic, had to have impacted wisdom teeth removed. She was refered by her Dentist to a Dental Surgeon, who by all accounts is competent and efficient. The procedure was done under sedation in his rooms and was successful. But Caroline didn't wake up afterwards as quickly as the dental surgeon expected. Based on her drowsiness, he thought that she must have low blood sugar. But he didn't have a blood glucose monitor to verify this. So he sent his nurse out to buy one from the pharmacy. And, to be on the safe side, he injected glucagon and called the ambulance.

By the time ambulance arrived, the nurse had returned and they were trying to get the newly acquired monitor to work. The paramedics used their meter, which read "HI", presumably because of the glucagon. They took her off to the emergency room anyway, where she was kept under observation until the next morning.

The boyfriend, who was there the whole time, related this story to me. As you can imagine, Caroline wasn't amused. In addition to having a sore jaw from the surgery, she also had a headache from the high blood sugar. And she had to spend a day in hospital. She is pretty sure that her blood sugar was in the target range when the glucagon was injected, and that the dental surgeon jumped to the wrong conclusion. But I guess we will never know exactly what happened.

I was dismayed to learn that medical professional would perform a surgical procedure on a T1 diabetic without having access to a blood glucose meter. Surely this is unprofessional. Or am I being unreasonable? What do you think?

I have to ask why Caroline didn't have her own meter with her?
It is not the dentists responsability to provide one.
He did what anyone else would have done treated for a low just in case a low is more dangerous than a high.
I side with the dentist he did all he was required to do.

I know for a fact my dental surgery does not have a meter on the premises. They do have a fully stocked medicine cabinat though. Thus can treat any emergency's as required.

[palefacegirl03]

Sorry that your daughter had to go through this. I just had a tooth removed , only "laughing gas" and novocain in reg dentists office. I checked my sugar before and when it was done, and showed the dentist before hand where it was, if needed.
I always take my meter with me to the dentists, dr, grocery store or gas station on the corner, whereever I might need it, better safe than sorry.
I tested my sugar duing labor with my daughter and all during the hospital stay, yes they could have done it, but they dont know my diabetes , like I do.

I will be having alot of dental work in the next few months, so my meter will go where I go.

[Just Ducky]

I have to go with the surgeon on this one. I do not think oral surgeons are required to have meters in their office and I honestly cannot imagine leaving home without my own, much less to have oral surgery performed. When I had my wisdom teeth removed, that was my number one concern and I made sure they knew it was in my bag, knew how much Lantus I'd taken that day (which, per my surgeon's instructions was half the regular dose, which worked beautifully) and knew what my glucose was prior to the surgery.

I guess my first thought is be hopeful your daughter learns to be more careful as she gets older and be grateful to have had an oral surgeon who erred on the side of caution. Had it been low blood sugar and he did nothing, this would be a VERY different conversation.