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JordansMom

Need advice on Oral Surgery for Type1 14-year old

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JordansMom

Hi!  My 14-year old daughter is having a major oral surgery (4 impacted wisdom teeth in down in the jaw bone) at the end of this week.  They are putting her completely out and she will be in surgery for a few hours, but she is wearing a CGM so we can see if she is going low.  Our plan is to keep her higher, but as all of you T1D parents know, that doesn't mean they won't drop unexpectedly.  We are also worried about managing her blood sugars when she can't eat.  We always notice that when she eats less than usual, she has lows even when we don't give bolus insulin.  We'll decrease her basal insulin, but she's never done a fast on the pump, so we'll be guessing. We have been lucky that in the 4 years since she's been diagnosed, she hasn't gone through any major illness.  Any advice that any of you can give who have gone through this would be much appreciated.  I just read on the young adult forum that steroid shots doctors give to ease swelling can jack blood sugars way up??  Also, I guess we need to be careful about keeping her sugars higher in general as it can cause bacterial growth and inhibit healing.  Feels like we'll be walking a tightrope!  Thanks for any help.

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JohnSchroeder

Really it sounds like you are on top of it.  I was probably a bit older than that when I got mine out, no issues.

 

Keep her a bit high going in... 150-200 is probably not unreasonable, make sure you haven't done a huge bolus in the morning.  And keep plenty of sugared sprite and gatorade on hand for the next few days.

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sillygirl

I had this surgery for 4 impacted wisdom teeth. 1 had abscessed with a tumor under it and one of the others had just a tumor. The wisdom tooth abscessing actually saved my jaw. Back to my point.... The anesthesia is not the same as what they use in the hospital for surgery. They put you in what's called twilight not quite asleep and not quite awake. I dont know how this will affect bg. I might not at all, but i am sure the doctor will be prepared in case it happens. Just a heads up.... In my sleep i cried the entire time which my mom was able to hear. She about flipped out. This is normal some people also laugh the entire time. I felt absolutely no pain during or right after the surgery. Well after the surgery I was only able to/ wanted to eat ice cream and jello. The cold helped manage the pain and was very comforting.  You can alternate higher carb ice cream with sugar free jello pudding as needed. My cousins liked cold shakes as well. If there are protein shakes she likes that might help as well. None of us had any kind of appetite. 2 to 3 bites of ice cream was about all we ate at any given time the first 2 days. The pain even with a pill is quite intense for at least 3 days. You will probably need to worry more about lows than about highs unless any of the meds have residual effects.

 

I wouldnt recommend sodas, gatorade, acidic juices, anything salty, or really anything that needs to be chewed or has any kind of firm texture. Her mouth will probably be too sensitive for that.

 

She wont be able to brush her teeth for several days. My doctor gave me a special rinse to use. This was a prescription not something you can buy in the store. That stuff worked miracles in my mouth. It didnt allow anything to grow in my mouth.

 

I dont think that i received a steroid shot at all. You definitely want to talk to the doctor because they can really wreak havoc with your bg. He might be able to give you an alternative. The cold foods also help with swelling dont have anything even warm the first couple of days.

 

Hope  this helps

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Kit

. In my sleep i cried the entire time which my mom was able to hear. She about flipped out. This is normal some people also laugh the entire time. I felt absolutely no pain during or right after the surgery.

 

They did something similar on me when I had my wisdom teeth removed.  Too many teeth for my little mouth.  (Mr Fuzzy says "HA!  You've got the biggest mouth I have ever seen except for maybe your mother!"  Maybe I should slap him one.)

 

Anyway, I woke up just sobbing.  Body shaking, heart wrenching sobs and I could not stop.  They asked me if I was in pain.  I don't remember ever feeling anything but minor discomfort for days afterwards.  They asked me why I was crying and I answered with 'I don't know".  Its funny how things can affect you.

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JohnSchroeder

Holy Cats you two!  JordansMom is probably going to cancel the surgery now!

 

JordansMom... I did it awake (numbed obviously) with a little bit of gas and got through it just fine.  Both my mouth and my diabetes.   After those two horror stories, you might need a cute puppy picture.  here you go!

 

tumblr_nz10tuNhfp1rbibvmo1_500.jpg

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Kit

Aww, mine wasn't a horror story.  I just find it funny that I was crying so hard.  I didn't hurt at all.  Once the drug wore off I was just fine.  :)

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sillygirl

My surgery was excellent. It was just a normal reaction to the anesthesia. I just figured it was better she was prepared instead of freaked out like my mom. No one told my mom this might happen till she was half way out of her seat ready to kill to protect her baby.

 

Dont cancel the surgery. One of my cousins didnt have hers removed and oh the dental issues she has had her whole life due to crowding. Not to mention how uncomfortable she is with her smile.

 

Mine might have been a bit more painful than most due to my added issues, but I will say the pain pills worked wonders.  My cousins all said it was uncomfortable. They stayed on the pain pills a bit longer than i did though.

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JordansMom

Thanks so much to all of you!  Everything you've told me is really helpful.  I'm glad I know that she might do something like cry, so I don't freak out.  I guess her oral surgeon will be putting her out deeper than twilight, due to the issues he expects to have during the surgery.  But she's happy about that actually.  The advice is much appreciated... I'll ask Dr. about the rinse and the steroid shot, and I'll stock up on cold soft stuff.  Thanks again!

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kstiles

It sounds like you've got a really great plan. One option, if she does go low and can't eat or drink at all, is to do a glucagon mini-dose with a regular insulin syringe. You can mix the glucagon and draw up like 15 or 30 units and give her the injection subcutaneously. That will raise her blood sugar a bit, but not nearly as much as if you'd given her the entire glucagon injection. Good luck! Oral surgery is not fun at all!

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JordansMom

That reminds me... I better check the expiration on her glucagon!  Especially in case of emergency.  (Am I the only bad parent who forgets these things?)  Thanks for the reminder!

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kstiles

That reminds me... I better check the expiration on her glucagon!  Especially in case of emergency.  (Am I the only bad parent who forgets these things?)  Thanks for the reminder!

Just remember - in a diabetic emergency, an expired glucagon is better than no glucagon. In my experience, expiration dates on meds are merely a suggestion... :)

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JordansMom

Thanks, yes I've heard the glucagon lasts a lot longer than the expiration date... I think even Jordan's medical provider told us that.  I got a new one just in case.  In the 4 1/2 years since she's been diagnosed, we've never had to use it yet (knock on wood).

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