Case 1
A patient with type 1 diabetes mellitus is seen for dental care
Ira B. Lamster, DDS, MMSc; Nurit Bittner, DDS, MS; and Daniel Lorber, MD
A 31-year-old woman with type 1 diabetes presents to her dentist for periodontal and prosthodontic care. A fixed partial denture is needed to replace tooth #4. Teeth #3 and #5 require crown lengthening procedures.
Medical history
The patient was diagnosed with type 1 diabetes mellitus at the age of 15. Medical management of her diabetes is with a multiple-dose insulin regimen, consisting of insulin glargine 16 units hs (long-acting insulin, see Table 1) and insulin aspart (rapid-acting insulin, Table 1) before meals. The dose of insulin aspart is calculated based on the carbohydrate content of the planned meal and the blood glucose level as determined by a fingerstick test. Her most recent hemoglobin A1c (HbA1c) was 6.8%, indicating excellent metabolic control. She has no history of severe hypoglycemic events. She takes no other medications.
| Insulin preparation | Onset of action | Peak | Duration of action |
| Lispro (Humalog ® ) | < 15 minutes | 1–2 hours | 3–6 hours |
| Aspart (Novolog ® ) | < 15 minutes | 1–2 hours | 3–6 hours |
| Glulisine (Apidra ® ) | < 15 minutes | 1–2 hours | 3–6 hours |
| Regular (Novolin ® R, Humulin ® R) | 30–60 minutes | 2–4 hours | 6–10 hours |
| Humulin ® R Regular U–500 |
30–60 minutes | 2–4 hours | Up to 24 hours |
| NPH (Novolin ® N, Humulin ® N, ReliOn ® ) | 2–4 hours | 4–8 hours | 10–18 hours |
| Glargine (Lantus ® ) | 1–2 hours | Usually no peak | Up to 24 hours |
| Determir (Levemir ® ) | 1–2 hours | Usually no peakb | Up to 24 hours b |
| Premixed insulins c | Onset of action | Peak/> |
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