Influence of Diazepam on Blood Glucose Levels in Nondiabetic and Non-Insulin-dependent Diabetic Subjects Under Dental Treatment With Local Anesthesia. DISCUSSION

In: Health

10 Sep 2009

Nondiabetic Diabetic DISCUSSIONAlthough it is well known that stress can increase blood glucose levels, as shown in previous experimental studies in *diabetic and nondiabetic animals and humans, it is difficult to standardize the type of stress and to generalize the conclusions from one study to another.

Some authors consider dental treatment a stressing procedure, and as such it could induce an increase in blood glucose levels.

Although there are conflicting reports regarding the effect of diazepam on blood glucose concentration in humans, the use of benzodiazepines to control anxiety is widely accepted.

In nondiabetic patients, Metha observed a significant fall in blood glucose level with atropine and atropine and diazepam premedications, with no significant difference between the 2 treatments, suggesting that the fall in blood glucose could be due to preoperative starvation. With regard to the fasting period, Paul and Bhat­tacharya observed that prolonged preoperative starvation causes a progressive fall in blood glucose concentration, but premedication with 10 mg diazepam IM prevented this fall and even caused a slight but insignificant rise in the blood glucose level. In both of these studies a 12-hour preoperative fasting period and 10 mg diazepam IM were used. Medication you can afford levitra plus

Similarly, Syvalahti and Kanto observed a tendency for blood glucose levels to rise after administration of 5 or 10 mg diazepam orally or 10 mg IV to 10 healthy volunteers. A dose-dependent rise in growth hormone (GH) was also observed, with no changes in the serum immunoreactive insulin after diazepam administration. In insulin-dependent diabetics, Ajlouni et al observed a rise in GH, but the plasma glucose concentration did not change significantly after administration of 10 mg diazepam orally.

On the other hand, according to Cuparencu and Hor-ak, in “diabetic rats diazepam administered subacutely elicited very significant diminutions of glycemia.” Likewise, Surwit et al showed that alprazolam significantly reduced blood glucose concentration in obese mice. The authors suggested that benzodiazepines could have a role in the modification of stress hyperglycemia in non-insulin-dependent diabetic subjects.

Blood Glucose Concentration (mean ± SD, mg/dL) of Non-Insulin-dependent Diabetic and Nondiabetic Volunteers in Each Session and Time of Blood Sample*

Time Session Nondiabetic Diabetic
TO Baseline

92.4

± 7.48 147.2 23.00
Diazepam

96.2

6.77 150.2 27.89
Placebo

98.4

9.40 149.7 -f- 24.86
Tl Baseline

102.5

24.59 186.2 28.00
Diazepam

92.2

23.93 176.9 34.76
Placebo

91.0

20.92 172.8 47.95
T2 Baseline

94.9

26.20 170.9 34.81
Diazepam

87.9

20.17 170.6 34.81
Placebo

93.9

19.32 175.8 45.80
T3 Baseline

92.6

20.12 174.1 32.44
Diazepam

88.0

17.30 171.9 35.54
Placebo

95.2

12.52 172.4 46.29
T4 Baseline

82.6

11.49 158.3 35.69
Diazepam

88.9

+ 14.01 162.4 39.15
Placebo

95.8

7.37 170.7 52.84
T5 Baseline

79.0

8.01 136.6 32.91
Diazepam

79.4

+ 8.34 152.3 38.49
Placebo

89.2

± 12.36 159.5 47.30

In humans, Okada et al observed that the chronic use of fluodiazepam for 12 weeks was effective in reducing glycosylated hemoglobin and the chronic anxiety level in non-insulin-dependent diabetic patients.

The results of this study show that although dental treatment can be stressful, scaling and root planing does not seem to stress patients, as no alteration on blood glucose levels, blood pressure, and heart rate were observed in all of the experimental sessions. As observed by other researchers, the administration of diazepam did not alter blood glucose concentration. It must also be considered that in this experiment, there were no extremely anxious patients. Source your medication needs online. Canadian healthcare viagra home delivered.

Besides stress, adrenaline-containing local anesthetic is another important factor that could contribute toward increasing blood glucose concentration, as seen by Mee-chan and Meechan and Welbury. In both studies, significant differences were found when adrenaline-containing local anesthetics were injected in sedated and unsedated nondiabetic volunteers and patients who un¬derwent surgical procedures. The authors claim that in non-insulin-dependent diabetic patients, this change could be of importance, as adrenaline increases blood glucose by the mechanism of inhibiting insulin release. However, Esmerino et al did not observe significant


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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