Diabetes and the risks of surgery

The Risks of Surgery

In addition to the normal Risks of Surgery, diabetics face additional risks when having a surgical procedure. These risks are heightened if you have had 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.

The Risks Diabetics Face After Surgery:

• Hyperglycemia (high blood glucose) Or Hypoglycemia (low blood glucose)
• Poor wound healing, slow wound healing, weak skin and 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 

What Diabetics Can Do to Be a Better Surgical Candidate

The better your control of your diabetes, the better your chances of an excellent surgical outcome. Keeping your blood glucose within the parameters your doctor recommends is key. 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 ability to withstand the rigors of surgery.

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.

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.

If you drink 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.

What to Expect During Your Hospital Stay

The way your diabetes is managed at home may be very different from how it is managed in the hospital. One good example is the use of regular insulin given by IV, rather than the other types available. Most doctors, especially in the time immediately surrounding surgery, will not want oral medications or long acting types of insulin to be given. Regular insulin works within a short time, allowing the staff to have a much better idea of your glucose level. This allows them to treat elevated levels, or low levels immediately. In some cases, blood glucose testing will be done as frequently as every two hours, with medication coverage provided as needed.

Your glucose level may be maintained in a much narrower window during your hospital stay. This is because studies have shown that the better controlled blood glucose levels are, the faster the healing. If you are going to have meals during your stay at the hospital you can expect to receive diabetic meals, which are designed specifically for diabetics by the nutrition staff.

If you are having outpatient surgery, or have to report for your surgery that morning, consider bringing along your glucose meter. If the surgery is delayed for any reason, you will be able to test your glucose level as needed and notify staff as appropriate.

Talk To Your Surgeon About Your Diabetes

• Who will manage my diabetes during my hospital stay, the surgeon, my endocrinologist, my family physician?
• Who will manage my diabetes during the surgery? ("It isn’t necessary" truly is not an acceptable answer unless your surgery will be VERY fast. During surgery the anesthesia provider can give you insulin or glucose as needed to keep your blood glucose level within the acceptable range, at the request of the surgeon.)
• Should I take my insulin the morning of the surgery?
• Should I take my nighttime does of insulin?
• What would you like me to do if I have an episode of low or high blood glucose the morning of surgery? 
• When should I have my last meal/fluid prior to surgery?

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. You may want to take your temperature regularly as another way to detect infection.
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