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

Anxiety and fear are frequently related to dental treatment and are of major concern to dentists. Stress can lead to an undesirable increase of heart rate, blood pressure, and blood glucose levels. The fight or flight response caused by stress includes sympathetic discharge and elevations in circulating levels of catecholamines, glucocorticoids, and growth hormone, resulting in an increase of blood glucose levels.

It has been shown that stress can induce hyperglycemia in several animal models of type II diabetes. There is evidence that the a-adrenergic stimulation may have a greater effect on insulin release in type II diabetic patients than in normal subjects. Mcleskey et al observed that diabetic patients show excessive hyperglycemia during surgical stress compared with normal subjects.

The use of adrenaline-containing local anesthetics could also contribute to the increase in blood glucose levels, as seen in healthy volunteers, although this is still a matter of controversy, as no alteration on blood glucose levels were seen either in alloxan-diabetic rats or in insulin-dependent diabetic patients after receivingadrenaline-containing local anesthetics. The literature shows that non-insulin-dependent diabetics present a higher degree of anxiety than healthy patients.

The benzodiazepines are the most prescribed medication in the world, being the drugs of choice for oral sedation and relief of anxiety before dental treatment. There is evidence that chronic use of benzodiazepines (fluodiazepam) is effective in reducing chronic anxiety, as seen by Okada et al in non-insulin-dependent diabetic patients. However, some studies showed that single-dose benzodiazepines may not reduce blood glucose levels in healthy patients or in insulin-dependent diabetics.

Therefore, the purpose of this study was to investigate whether a potentially stressful situation, the scaling and root planing under local anesthesia with a vasoconstrictor, could alter the blood glucose levels in non-insulin-dependent diabetic subjects, and what influence pre-anesthetic medication with diazepam had on this parameter, as compared with normal subjects.