My daughter who is 16 is having her wisdom teeth removed under general anesthesia. The doctor has advised to go easy on her tresiba to ensure she’s not low during the surgery. Any other words of “wisdom” or things I should be aware of?
Great question! My oldest (nonD) son got his removed yesterday. It was quick and uneventful - less than a half an hour. I thought about what I would do if Caleb needs to have his removed. I would definitely target a higher bg starting overnight bc of fasting instructions and keep a higher target until I am confident he’s able to eat regularly. I’d approach it similar to a stomach bug.
Colin came home and had a milkshake, then pasta, then scrambled eggs and rice with a gelato chaser. All has gone well so far, knock wood.
Good luck. I’ll be watching for advice from those who have been under general anesthesia!
As with any surgery, make sure the doctor and team are prepared to work with a diabetic. We’re a special breed. The anesthesiologist who is part of the surgical team should be comfortable with diabetic patients and have the necessary things on standby if they’re needed. They’ll probably start her on a glucose IV during the surgery to prevent her from dropping low.
As @Lorraine has suggested, I’d target slightly higher than normal blood sugars going into, coming out of, and for a short period of time after the surgery. Treat it like you would a bad flu/stomach bug.
If your daughter has never been under anesthesia before, prepare for someone who’s pretty groggy and possibly sick to their stomach when they wake up and for the time period shortly afterwards. Keep fast-acting sugar and glucagon handy if you can, just in case it’s needed.
Personally, I’d test a bit more regularly than normal - kind of like a sick day.
Some people experience pain and swelling, sometimes bruising, and others experience none of it. I was fortunate to be eating about 30 minutes after mine were removed.
Best of luck to you and your daughter!
Great advice. She had her tonsils removed pre-D and was eating jello and broth by that evening, so I am hoping ths will be similar. Yes, I will cut back a few units on her Tresiba a few days beforehand and control her with rapid - better that way than forcing carbs to bring up a slow basal low. Thanks for the glucagon reminder - I will bring that to the surgery.
Also, rice pudding & all types of puddings would feel soothing.
And a reminder to check the expiration date on the glucagon… the stuff is only good for a short period of time, and often times I have to set a reminder to go pick up another one otherwise I’d forget since it’s not something that we generally use unless it’s an emergency situation.
My 19 yr old had all 4 wisdom teeth removed last November. We lowered her basals at 5am. She went under at 8:15, with BG at 130. I gave the Dexcom to the surgeon (he was also administering anesthesia) & explained how to work it. Half an hour later they called me back to take her hom. BG was between 120 & 130 throughout. She did only liquids for 2 days (her choice). Lots of smoothies, soup & water. She did fine. A few lows into the 60s but nothing a little juice couldn’t handle.
When under General anesthesia the anesthesiologist should be checking the numbers with a Glucose meter! I would make sure they do that!
Meters can be off by +/- 20. If her Dexcom hadn’t been accurate in the days leading up to the procedure i wouldn’t have trusted it. After 8 years with Dex, I’m confident in my ability to judge when to trust it. To each their own.
Also, I don’t know of any oral surgeons in my area that use an anesthesiologist. The surgeons are all certified in the anesthesia they use. My part of the world must be unusual.
Potentially it could also depend on the type of anesthesia used as well. I would be fine with sedation anesthesia being done by the oral surgeon (obviously assuming they are trained and certified for such) but for general anesthesia, I would not agree to the procedure without a dedicated anesthesiologist being on the team.
I still wonder why in the US basically ANY wisdom teeth removals are done under GA. Here, i have the impression that its only for “tough cases”.
So i had mine removed under local anasthesia, 2 at a time. I went into the procedure with a BG of 10, that was the only precaution i took. I know that for GA thats different.
A few recovery tips:
After the removal i ate mashed potatoes for a week. Icing the cheeks is key to good pain management!
Be aware that dexcom and paracetamol dont mix well. And maybe only bolus after your daughter is sure that she will be able to finish the meal.
For me, recovery was harder than the procedure itself. Not being able to eat properly and having those stitches in my mouth was not fun! So taking them out right before the holidays is very brave of your daughter!!
When I visited an Oral Surgeon (USA), the information I was given is that the anesthesia depends on the situation.
I had one wisdom tooth removed with only local. The Doc said it was going to be an easy one so not worth any trouble. Certainly I was nervous but trusted him and he was correct. He said the other three were going to be more work. So, I still have 3. lol.
So it turns out I was off base. It’s just sedation by IV, not general anesthesia she will be under. Not until February, so we have a bit of time.
She wears a CGM, so I would make sure the sensor is a few days old and has been calibrated that morning.
Conscious sedation is the norm where I live. No general unless you’re admitted to the hospital. My daughter was awake, talking & walking when I came into the room. Half an hour later I had a couple of short funny videos & she was spooning milkshake into her mouth like someone was going to steal it. Lol I worried a lot for nothing . It was actually faster & easier than when her oldest sister went through 20 years ago.
I’d not do them all at once. I had all of my out in one day in my 20’s and I had pain for 6 months after. As for the bg I tend to drop with Novocaine etc so I’d be careful. Even when they use the one without epinephrine. Then I need more because it’s not as effective. My podiatrist said d patients need higher doses to kill pain. I needed 2-3 shots for my last toenail surgery.
For the wisdom teeth, long before d, they gave me sodium pentathol, some type of gas, and novocaine injections. I was mostly out.
I have been under general anesthetics several times. Unsually on an empty stomach. I tell the medical team each time that I am diabetic and have not eaten. They tube me some glucose during the procedure. I check my numbers when I wake up. No problems with surgery.