As a dentist, i have noticed that many who claim to be "controlled diabetics" seem to burn through local anesthesia at an alarming rate. any insight?

Excessive adipocytes: As far as local anesthetics, there is no physiological explanation i can think of except maybe that the amount of adipose tissue makes either their anatomy less predictable as far as nerves. The adipose tissue might alter the usual anatomy so your blocks are more spotty.

Not sure: Have not read anything specific so far, yet can relate that on labor floor epidural infusions do seem to be different in, say, obese preeclamptic pts, for example. Were they on oral agents?

"Diabetic": Firstly I am not a fan of the term diabetic for those with type 2 diabetes. The goal for dm2 is to work towards eliminating the diabetes. Doesn't happen often enough but when it does the patient lets all their friends know and helps them reach the same goal. Don't automatically accept that they are "controlled". Either contact their pcp or bring in a blood glucose diary for you to review.

Different Anesthetic: It is possible that there are unknown factors but if i was having this problem i would switch to a different anesthetic, i like septodont with epi especially for max injections and Lidocaine for ia, injecting under the periosteum to keep the anesthetic from diffusing into the soft tissue especially in fatty sites. I would use epi even if they had a slight h bp.

Patient on Drugs: Could it be related to the similarity that we know about the more "drugs" (specifically pain killers) a person is on (legal or illegal) the more and faster rate their body metabolizes the local anesthetics. They have conditioned their body by this type of abuse and the body has responded as such.

Not noted: I suspect the question might revolve around how they are "controlled" -- diet, insulin, both ? Is it a circulation/capillary issue, drug interaction, liver function issue. Haven't seen it during my 35 years of practice. Will keep eyes open to this.

Yes, it is possible: In patients with good glycemic control before starting any dental procedure, ask if the patient has taken medication and food as usual. To avoid hyperglycemia use anxiety reduction protocol every appointment.

Neuropathy: I have expanded on a German treatment for neuropathy 1) Alpha lipoic acid 200-300 mg po 2-3 X/d 2) B-complex 1 po qd 3) magnesium glycinate/citrate 300 mg po bid 4) cod liver oil (FLAVORED) 1 TBS qd I would have the patient do this for a minimum of 6-8 weeks before any elective procedure. This regimen actually nourishes and heals the damaged nerves. The patient should stay on this regimen indefi

Neuropathy: Suspect that especially with type 2 diabetics who have the sequelae of nerve damage often even before the are diagnosed with diabetes have hyperalgesia. As a result, the local anesthetic is less effective due to reduced blood supply and the response to pain stimulus is exaggerated