No Laughing Matter: How This Dental Anesthetic Affects Blood Sugars

Nitrous oxide is an effective and safe sedative agent. When mixed with oxygen, it can help people relax during medical procedures. It is especially helpful for people who experience anxiety.

It is delivered through a small mask that fits tightly over your nose. It is different from anesthesia, where you essentially go to sleep for a procedure. Laughing gas simply gives you a calm and relaxed feeling, with no leftover effects once it wears off.

Although people can sometimes feel sleepy while taking nitrous oxide, they will still be able to respond to the dentist.

If you have anxiety before dental procedures, nitrous oxide may be an excellent option for you.

Dentists prefer using it because:

• The amount of sedation can quickly be dialed up or down.
• It works extremely quickly (takes effect after a few minutes).
• It is extremely safe for the brain, heart, liver, lungs, and kidneys.

It’s helpful for very young people, as well as those with severe anxiety or with disabilities, including diabetes.

The medication is simple and easy to administer through a face mask. Plus, there are no lasting side effects. However, nitrous oxide does have some short-term side effects and downsides.

Nitrous oxide is safe and effective for both adults and children with both type 1 and type 2 diabetes, according to 2020 research.

Before recommending treatment with nitrous oxide, a person should talk with their endocrinologist or diabetes care team about average blood sugar levels and A1C levels. They should also discuss medications and treatment options to make sure nitrous oxide is appropriate.

It’s especially important to be aware of how to prevent low blood sugar during any dental procedures requiring nitrous oxide.

Using nitrous oxide usually requires a multi-hour fast, typically about 6 hours before the dental visit. That means scheduling an appointment in the morning (with fasting occurring overnight) may be easiest for someone with diabetes. Blood sugars often run higher in the morning, and that can be helpful to prevent hypoglycemia.

For children with diabetes, a dentist may not be able to treat a child if their blood sugar level is 250 mg/dL or higher at the time of a dental appointment, according to the Louisiana State University School of Dentistry.

While there is not any scientific research focused on laughing gas and the effect it has on glucose levels, anecdotal evidence from the Diabetes Online Community is that it largely does not raise or lower it significantly during the procedure.

Some people state that any fluctuations are more likely caused by anxiety and stress, which both do raise glucose levels in people with diabetes.

For people with diabetes, nitrous oxide can be somewhat tricky, as you may not feel low blood sugars as effectively if you’re mildly sedated:

• Most importantly, make sure your dental team knows that you have diabetes and what to do in the case of an emergency with severely low blood sugar.
• It’s important to use a temporary basal (if you’re on an insulin pump).
• Wear a continuous glucose monitor (CGM) with low alerts turned on to make sure that your dentist can hear if you’re going low during a procedure.
• Always carry low snacks (especially glucose gel that can be quickly absorbed into your gum without the need for chewing!) with you when going to the dentist.

1. Most dentists will ask that you fast for at least 6 hours before receiving nitrous oxide, which can be difficult with diabetes if you have frequent low blood sugars.
2. Drinking clear liquids is usually fine about 2 hours before a treatment, so managing low blood sugar with clear juice should be just fine. That said, having an empty stomach when on nitrous oxide can help prevent nausea and vomiting. This is something that you should talk with your dentist about if you have concerns about the strength of nitrous oxide and experience with lower blood sugars, especially before a procedure.
3. Try to avoid scheduling a dental appointment after strenuous exercise or during a meal that you usually rely on for carbohydrates. This can also increase the likelihood of low blood sugars during a procedure. Work with your doctor to either reduce your insulin dose the day of a procedure or use a temporary basal setting on your insulin pump to help ward off low blood sugar levels. Always carry low snacks with you and turn on your low blood sugar alerts if you wear a CGM, so your dentist can intervene in the case of a hypoglycemic episode.

Proper dental health is extremely important for people with diabetes. According to the American Dental Association, this condition means you’re more prone to cavities, gum disease, and dental decay.

It’s crucial to incorporate regular dental visits with your diabetes care, but sometimes dental procedures can become quite involved and scary. This may require mild sedation to help you cope, like nitrous oxide.

Though side effects are possible from laughing gas, those are not a common occurrence in general.

Common short-term side effects include:

• excessive sweating
• shivering
• nausea
• vomiting
• dizziness
• sleepiness

Some people also experience hallucinations or sound distortion after inhaling nitrous oxide.

People should receive increased oxygen after the nitrous oxide is turned off to help prevent some of these side effects. You should only drive home after any side effects have worn off.

If you are using nitrous oxide for longer-term use, take a B12 vitamin to prevent anemia.

With time and attention paid to prepping properly before a dental visit, using nitrous oxide can be an effective way to manage dental anxiety without wreaking havoc on blood sugar levels.