It is very commonly found in diabetic population that their planned surgery for any complication of diabetes such as organ failure or even minor surgical procedure is cancelled on time. This is due to the risks of surgery associated with high blood sugar levels. In addition to the normal risks of surgery, diabetics face additional risks when having a surgical procedure. These risks are heightened if you have:
- Diabetes for an extended period of time.
- Frequently have high blood sugars.
- Or if you are a brittle (have difficulty controlling your glucose level) diabetic.
- Patients who have already experienced major complications from diabetes, such as neuropathy or requiring an amputation are also at higher risk.
RISKS THAT CAN ORIGINATE FROM SURGERY UNDER DIABETES
The surgery for diabetics is carefully performed and monitored due to the following given risks that might originate after surgery:
- Hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose)
- Poor wound healing, slow wound healing, weak skin & tissue at site of surgery
- Infection, including infection of the wound, pneumonia, urinary tract infection or sepsis
- Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK)
- Diabetic Ketoacidosis (DKA)
- Electrolyte Imbalance – A condition where electrolyte levels (sodium, potassium) rise or fall significantly, which can cause significant problems with the heart and the body’s fluid levels.
- Sexual dysfunction
To avoid these complications of surgery under diabetic condition, following points should be kept in mind before surgery:
- Work with your doctor to come up with the safest surgery plan for you.
- Focus more on controlling your diabetes during the weeks before surgery.
- Your doctor will do a medical exam and talk to you about your health. Surgery is riskier if you have diabetes complications. So talk to your doctor about your diabetes control and any complications you have from diabetes. Tell your doctor about any problems you have with your heart, kidneys, or eyes, or if you have loss of feeling in your feet. The doctor may run some tests to check the status of those problems.
- Tell your doctor about all the medicines you are taking.
- If you take Metformin, talk to your doctor about stopping it. Sometimes, it can be stopped 48 hours before and 48 hours after surgery to decrease the risk of lactic acidosis.
- If you take insulin, ask your doctor what dose you should take the night before or the day of your surgery.
HOW TO IMPROVE YOUR SURGERY RESULTS AS A DIABETIC?
- Maintain your blood glucose levels
The better your control of your diabetes, the better your chances of an excellent surgical outcome are! Keeping your blood glucose within the parameters your doctor recommends is the key to successful surgery.
- Consume nutritional diet
Top-notch nutrition, including high-quality protein, is also essential. Protein is an important component in the healing process and can help contribute to faster wound healing, stronger tissue at the surgical site and an increased abi lity to withstand the rigors of surgery.
- Physical activity – exercise
If you aren’t already exercising but you are able, you may want to start an exercise program after checking with your doctor. Making your body stronger is going to help you better tolerate your surgery and recovery.
- Relieve stress as much as possible
Try not to get overly stressed about your surgery. If you are feeling anxious about your surgery, coping with surgical fear and anxiety may help. It is important to keep stress to a minimum because both physical stress (the surgery) and emotional stress (worrying, anxiety) can work against you by elevating your blood glucose levels.
- Quit smoking & drinking alcohol
If you drink alcohol or smoke, this is the time to stop. Eliminating alcohol will help you better control your blood glucose and quitting smoking will help you return to breathing without oxygen or a ventilator faster.
IMPORTANT QUESTIONS DIABETICS SHOULD ASK THEIR SURGEON
- Who will manage my diabetes during my hospital stay, the surgeon, my endocrinologist, my family physician, a hospitalist?
- Who will manage my diabetes during the surgery?
- Should I take my insulin the morning of the surgery?
- Should I take my nighttime dose of insulin?
- What would you like me to do if I have high blood glucose during the morning of surgery?
- When should I have my last meal/fluid prior to surgery?
- If my blood sugar is low, what can I do about it that won’t complicate my surgery?
- Should oral diabetes medication be held or taken?
DIABETES AFTER SURGERY
After surgery, the need for high quality nutrition and tight glycemic control continues. Nutrition will provide the building blocks for healing and a normal glucose level will promote a quicker return to health.
Tight control of glucose levels could potentially shave days or even weeks off of your recovery period when compared to recovery times with elevated blood glucose.
Once the surgery is over and you are into your recovery phase, you will need to aggressively check for signs of infection in your healing wound; in addition to the normal checks you do (such as checking your feet for problems). If you have neuropathy, remember you may not feel pain until the infection is well established.
Signs of a wound infection include:
- Pus or foul drainage
- Fever greater than 101 degrees
- The incision feels hot to the touch or is angry red
- Pain around the incision that is getting worse instead of better
- Swelling or hardening of the incision site
It is absolutely possible for a patient with diabetes to have a safe and uneventful surgery followed by quick recovery. Well-controlled diabetes is far less likely to lead to complications than poorly controlled diabetes, making the extra effort to keep glucose levels in line.