Case 1: A patient with type 1 diabetes mellitus is seen for dental care

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.

Table 1 Insulin chart.a

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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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on Case 1: A patient with type 1 diabetes mellitus is seen for dental care
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