Monitoring Diabetes Before Surgeries

Diabetes is a worldwide endemic affecting millions of people. Diabetes is classified as type 1 diabetes which is normally genetic and type 2 diabetes which is more of a lifestyle disease. A person gets affected with diabetes when the pancreas does not produce insulin which is the only hormone in the body that can process glucose and sugars imbibed through the food eaten for energy requirements.

Common diabetes complications are retinopathy, neuropathy, kidney disorders, liver disorders, cardiac problems and stroke.  To avoid such risks, it is vital to maintain diabetes control and regularly monitor blood sugar levels with the aid of blood glucose monitors.

Diabetics need to be extra careful and sensitive to ailments and recovery/healing, especially in accidents.  Accidents and diabetic complications need surgery more often than not.

Causes of accidents due to diabetes:

• Retinopathy which causes impaired vision and cataract formation
• Affected ability to monitor vehicle pedals due to neuropathy or damaged nerves
• Sudden onset of a mild stroke

Whether a planned surgery or in an emergency surgery, people suffering from type 1 diabetes or type 2 diabetes need to maintain strict diabetes control. It is important to be attached to a diabetes doctor or a sugar clinic. Diabetes control will considerably improve the outcome of planned/unplanned surgeries.

3 reasons why diabetic wounds heal slower

1. With high blood sugar levels, blood vessels start thickening impeding blood flow. This means that nutrients and oxygen don’t reach cells making it harder to repair wounds. Lower blood circulation reduces the amount of vital oxygen causing cells to die—eventually leading to possible death of that organ or amputation. Keeping your blood sugar level stable by aerobic exercise and diabetes diet can help with diabetes control and help wounds and injuries heal faster.
2. Neuropathy- Diabetes and high blood sugar can cause nerve damage called diabetic neuropathy. Neuropathy causes tingling and numbness, which makes the mind and body insensitive to pain, tingling, delaying medical help. Small wounds and blisters, can go undetected especially on the feet. Because the body is not able to feel the hurt and repair itself effectively, wounds get worse, eventually turning into more serious issues that might require surgical intervention.
3. Reduced immune system function – The body’s immune system is responsible for keeping germs and other external infections out. If germs do get in the body, the immune system fights them off and stops infections. In diabetes, the body produces enzymes and hormones that reduce the efficacy of the immune system. This can lead to more infections, causing diabetic wounds to take longer to heal and may get severe enough to require medical attention.

When diabetic patients get hurt, they need to first monitor the high blood sugar levels with blood glucose monitors regularly. Medicate the wound and take care to avoid getting an infection or more severe conditions like gangrene, “keeping the wound clean and dry is important. It is necessary to help your immune system by keeping high blood sugar levels under complete control. If you notice anything out of the ordinary, talk to your diabetes doctor immediately”.

Nutrients and oxygen do not reach body cells because of high glucose levels making it harder to repair wounds. Diabetes and high blood sugar can cause nerve damage which is called diabetic neuropathy.

Risks and problems during or after surgery

• Infections after surgery
• Reduced or slow healing
• Kidney problems, loss of  fluids, electrolytes
• Heart problems

It is advisable for a person with type 1 diabetes or type 2 diabetes to keep complete diabetes control and connected to the diabetes doctor especially in case of planned surgeries because surgery is riskier with diabetes complications. The diabetes doctor should be aware of your body’s condition especially concerning eyes, blood vessels, heart, kidneys- in fact, your complete physiology.

Before your surgery, diabetes control is important so that blood sugar levels are controlled during surgery. Talk to your provider about your blood sugar target levels and other precautions to take well in advance of the operation.

• Who will manage my diabetes during my hospital stay
• Who will manage my diabetes during the surgery?
• Should I take my insulin at the time of before of the surgery?
• Should I take my nighttime dose of insulin?
• What to do during an episode high blood glucose the morning of surgery?
• Diet restrictions
• Will low blood sugar complicate the
• Should oral diabetes medication be held or taken?

Meet the anesthetist before surgery because insulin will be given by the anesthesiologist.  Discuss the plan to control blood sugar during the operation.

After surgery it is most critical to monitor blood sugar often because blood sugar levels may fluctuate get harder to control because:

• There may be  trouble eating
• Nausea or vomiting
• Post-surgical stress
• Inactivity
• Have pain or discomfort
• Some medication could aggravate  blood sugar levels

Some Tips before surgery

• Expect that healing may take more time because of diabetes. Be prepared for a longer hospital stay in case of major surgery. People with diabetes often have to stay in the hospital a little longer.
• Keep a watch for signs of infection, such as a fever, a swollen tender or red incision that is, hot to touch, painful or oozing.
• Prevent bedsores. Moving around in bed or getting out of bed frequently. With peripheral neuropathy, the sensation of getting a bed sore may not be there. Ensure movement of the body. Continue  towork with the diabetes care team to ensure diabetes control.

Diabetes adversely affects the outcome of all orthopedic surgeries like feet, ankle, upper extremities,  spine surgery, and sports medicine. Uncontrolled diabetes negatively impacts bone, soft tissue, ligament, and tendon healing. Complications of diabetes such as neuropathy, peripheral artery disease, and kidney disease which contribute to unfortunate results.

Diabetic patients with well-controlled blood sugar levels and without comorbidities have similar outcomes to patients without diabetes. It is absolutely possible for a patient with diabetes to have a safe surgery and quick recovery.

Well-controlled diabetes is very easy if the person follows a routine of diabetes diet, aerobic exercise, and constant monitoring with the help of blood glucose meters. These meters are part of a diabetes kit which also has glucometer strips and lancets for drawing blood, testing blood and storing results. Shift to a healthy lifestyle with exercise and diet regimen to reduce complications at a later stage.