February 17, 2007
Question from Steilacoom, Washington, USA:
I am a Registered Nurse. I frequently take care of my three-year-old niece. I had her last week and noticed her wetting her pants, which was new for her. Her paternal grandmother and uncle both have type 1 diabetes. I was hoping she just had a UTI, but had a sinking feeling it might be diabetes. They took her in and her blood sugar was too high to register on the meter, so she was sent to Children's Hospital in Seattle. Her blood sugar was 659 mg/dl [36.6 mmol/L], but she had no ketones in her urine. She spent four days at the hospital, then got to come home. She has spent the last two days with me to give her parents a break. She is on Lantus and Humalog. I noticed when she was brought back to me that she had what I thought was an abscessed front tooth. I took her to pediatric dentist yesterday (her one week anniversary diagnosed type 1) and, sure enough, she has an abscess. My real question is about the penicillin she is on. It is a suspension, I looked for information to see about the sugar content. It has saccharin, which I know is okay, and sucrose listed, but not how much. She is taking 5 mls, four times a day. Also, my other question is about celiac disease. The tooth that is abscessed, when it first erupted from the skin when she was a baby, had the appearance that it was missing a circular pattern of enamel. I thought I'd read something about teeth and celiac disease. Is this possible? Her mother did have a horrible pregnancy from 24 weeks on and developed a high fever/infection that could've affected her teeth. I'm just curious. The other thing is your opinion about her abscess. She will be having general anesthesia on Tuesday; they are going to extract the tooth, clean her teen, take thorough x-rays and put sealants on her. She will have to be NPO (nothing allowed by mouth) for some length of time. How do you handle the blood sugar issues with this?
There are a few issues to deal with here.
First, there are reasons for enamel defects due to being febrile. The teeth are developing as early as 16 weeks and fever seems to cause poor enamel formation. As for the celiac disease, the most common oral problem is mucosal in nature, but you will find enamel formation problems. However, there are specific ways to diagnose celiac disease with the physician.
Second, as for her being NPO, you will need to carefully consult on what insulin levels to administer with the physician. Being NPO is, as you know, due to the anesthesia and monitoring of blood glucose levels is imperative. She should do well and once the abscess is under control, then, you might see the glucose levels drop, so close monitoring is needed. I am an advocate of continuous glucose monitoring and this is one of those situations that I wish (even if a patient cant afford one) that home health would “rent” them for a short period of time.
Third, and just as important, is to develop a plan for preventive oral health with the pediatric dentist at this age to prevent long term oral health problems. Children do so well in the dental environment for some reason and get excited to have their teeth cleaned.
[Editor’s comment: Please see a previous question about children with diabetes and surgery.
See our web page on Celiac for more information on the disease.