I will be taking care of my neighbor’s 30 year old daughter who has Down syndrome and takes insulin after her four wisdom teeth are removed. None of the doctors will do this in the hospital so she will be cared for at home. I am sure you know it is very difficult to vary from normal routine.in people with special needs. Do you have any suggestions for diet during the first 48 hours after surgery

The first thing is to work with the diabetes specialist and dietitian/diabetes educator to establish baseline caloric needs. On the day of surgery, I am certain she will be sedated and will not have breakfast. Surgery should be in the morning, and the insulin dosing adjusted accordingly.

As for the surgery, insist on having extraction sites sutured and Gelfoam placed. Eatingwise, pudding and jello and milk are important. Careful, frequent blood glucose monitoring is essential,and pain management should be conservative.

Post-operative care after 24 hours should include alternating rinsing with warm salt water (saline) and Peridex (chlorhexidine rinse)). On a Down’s patient, rule out the need for antibiotic prophylaxis by the physician for underlying heart problems (heart murmurs). If the blood glucose average exceeds 200 mg/dl [11.1 mmol/L], antibiotics are imperative since the white cells will not work at these levels.

FV

[Editor’s comment: See Surgery Pre-Op Advice for some additional thoughts.

WWQ]