Special Needs

Diabetes & Special Conditions

elderly woman smilingDo you have diabetes or another medical condition that may require special care and attention?

Diabetes can give rise to multiple complications when providing dental care, and both our doctors and our team are well trained and capable of providing your dental care in coordination with the management of theses complications. Don’t risk other, less experienced practices - we regularly perform INR, Glucose and A1c testing right in our Venice, FL office.

More Info on Diabetes

Diabetes mellitus, also known as type 2, or adult-onset diabetes, is characterized by high blood sugar, called hyperglycemia. In type 2 diabetes, insulin, which is responsible for moving the sugar from the blood into bodily tissues, either becomes less effective or is produced in lesser quantity. This is in contrast to type 1 diabetes, where there is an absolute lack of insulin production due to breakdown of the islet cells that produce the insulin in the pancreas. Type 2 diabetes makes up about 90% of the cases of diabetes. Obesity is thought to be the primary cause of type 2 diabetes in people who are genetically predisposed to the disease.

Type 2 diabetes is initially managed by increasing exercise and dietary changes. If the blood sugar levels are not adequately lowered by these measures, medications such as metformin or insulin may be needed. For those on insulin, there is typically a requirement to check blood sugar levels regularly. We can check your blood sugar levels in our office, giving you added peace of mind at every appointment.


Development of type 2 diabetes is caused by a combination of lifestyle and genetic factors. The lifestyle factors that are known to be important are obesity, body fat levels, lack of physical activity, poor diet, and stress.


Type 2 diabetes is typically a chronic disease. There are many associated complications, such as cardiovascular disease, heart disease, stroke, blindness, and kidney failure. There is an increased incidence of hospitalizations, often leading to amputation of the extremities.


Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type 2 diabetic.

Medical Conditions

There are a number of medications and other health problems that can predispose one to diabetes. Some of these medications include:

Glucocorticoids: a class of steroids that are produced in the adrenal gland and appear naturally in humans and regulate the metabolism of glucose. They are also part of the feedback system that turns down the activity of the immune system and are therefore known as anti-inflammatories. They are used in medicine to treat diseases caused by an overactive immune system, such as allergies, asthma, autoimmune diseases and sepsis.

Thiazides: Hydrochlorthiazide (HCTZ) is a diuretic drug that increases the kidneys’ ability to eliminate water. It reduces blood volume by eliminating the water, therefore decreasing the volume of blood that returns to the heart, inadvertently, increasing the concentration of glucose in the blood.

Beta blockers: Beta-Blockers block beta adrenergic substances, such as adrenaline or epinephrine, which stimulate the heart. Drugs like atenolol, metoprolol and propanolol slow down the heartbeat, decrease the force of contractions of the heart muscle and reduce blood vessel contraction. They can also alter the glucose levels in the blood and mask symptoms of diabetes.

Statins: a class of drug used to lower cholesterol levels. An adverse effect is they increase the rate of diabetes by 9%.


The diagnosis of diabetes can be established by the presence of a group of the following symptoms.

  • Polydipsia or excessive thirst
  • Polyuria or excessive urine output
  • Polyphagia or excessive hunger
  • Weight loss
  • Loss of strength
  • Abnormal glucose metabolism
  • Fasting blood sugar (no calorie intake for 8 hours) at or above 126 mg/100 ml, which has become the standard laboratory test. We can perform this test for you in our office.
  • Levels of glycosolated hemoglobin (HbA1c) greater than 6.5%.

HbA1c is a form of hemoglobin that is measured primarily to identify the average glucose concentration in the blood over prolonged periods of time. It is formed when hemoglobin is exposed to glucose in the blood. In diabetes, higher amounts of glucose in the blood create higher amounts of glycated hemoglobin. Once the glucose attaches to the hemoglobin in the red blood cells, it stays that way until the red blood cell is replaced by the body. This serves as a marker for the average blood glucose levels over the months prior to the measurement. HbA1c testing is recommended for both checking blood sugar levels in people who might be pre-diabetic as well as for monitoring blood sugar control in patients with diabetes. For a single blood sample it provides far more revealing information on blood glucose than a fasting blood sugar value. However, fasting blood sugar levels are still crucial in making treatment decisions. In otherwise healthy people, a fasting glucose level of less than 110 mg/dl would be normal. In a person with diabetes, the fasting glucose level is sometimes greater than 126 mg/dl. In otherwise healthy people, an HbA1c is usually below 6.5%. A person with diabetes should maintain their HbA1c below 7.0%.

We have the training, ability and equipment to test both a fasting blood sugar level and an HbA1c percentage in our office.

What are the dental symptoms we might see in a diabetic who is not well controlled? Possibly xerostomia or dry mouth, bacterial, viral or fungal infections, poor wound healing, increased incidence of tooth decay and periodontal disease, or burning mouth syndrome.

How does treatment in our office differ for patients who have diabetes? If we have determined, with the help of your physician, that the disease is under good medical control, little or no special attention is necessary when receiving dental treatment. If there were to be an infection, such as an abscessed tooth, antibiotic treatment would be administered aggressively and immediately. Diabetic patients are always told to take their usual insulin dose and eat normal meals prior to their dental appointments, which are best scheduled in the morning. The goal is always to prevent insulin shock. This type of shock results from extreme fluctuations in blood sugar leading to hypoglycemia, or low blood sugar. The symptoms the diabetic patient would experience are dizziness, confusion, disorientation, weakness, and fatigue. This is a very serious medical condition and we would immediately stabilize the blood sugar levels by administering an easy to absorb form of glucose.

Further Questions? Contact Us

If you have any questions, or would like further information about diabetes, please send them to me in an email. My address is [email protected]. You can also set up an appointment using our online form or call us at the number on the bottom of this page.

I enjoyed summarizing my knowledge on and experience in dealing with diabetes, and I hope you will feel comfortable trusting your dental health needs to our team.

Ryan S. Holbrook, D.M.D. & Jose M. Horak, D.M.D.

  • Ryan S. Holbrook, D.M.D. and Jose M. Horak, D.M.D. - 200 Capri Isles Blvd., Venice, FL 34292 Phone: 941-484-3885

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