If you are reading this article, chances are that you are planning to undergo surgery in a near future. And that you have diabetes.
While undergoing surgery is always a nervous affair, it becomes a little trickier when it comes to people with diabetes.
People with diabetes generally undergo more surgical or other procedures than those without diabetes. It is estimated that 1 in 4 individuals with diabetes undergo a surgery at some point, which can negatively affect the sugar control and increase the risk of postoperative complications.
What makes surgery more risky for people with diabetes?
Surgery or other such procedures (e.g., bowel investigations) often require the patient to undergo fasting as well as change or stop certain medications before the procedure. Each stage of surgery, including anaesthesia, poses a challenge to maintain blood sugar levels in the target range. Along with this, the stress of the surgery itself affects the hormonal balance. While this is true even in nondiabetic people, in people with diabetes, ensuring good control of blood sugar levels around surgery becomes a critical issue.
However, with some precautions and strict sugar control, these risks can be considerably mitigated.
People with diabetes have higher postoperative complications.
People with diabetes undergoing any procedure (surgery, delivery, or a radiological procedure) usually have longer hospital stays, and their postoperative complications also tend to be higher than those without diabetes.
High sugar level further increases the risk of certain postoperative complications, with infection being the main culprit (66%). Thus, minimising the impact of such changes greatly improves the postoperative recovery.
The risks of the following complications increase in people with diabetes:
- Slow healing of the surgical wound, infection of the wound
- Electrolyte imbalance
- Diabetic ketoacidosis
- Other complications depending on the organs affected (e.g., cardiac surgery) and the duration of the procedure.
Precautionary measures to improve your postoperative outcome.
High blood sugar is the main cause of poor postoperative outcomes in people with diabetes. Therefore, it is imperative that diabetes is adequately controlled before the surgery (HbA1c < 6.5%), and hyperglycemia is prevented before, during, and after surgical procedures.2,3
- If sugar control is poor, the procedure should be postponed (unless it is an emergency procedure.)
- Consult your doctor about changing medicines or doses, especially if you are taking more than one anti-diabetic medications. In some longer surgeries, diabetes medications may be replaced with insulin.
- Ensure that you strictly comply with the diet and medication instructions given to you by the doctors. This is important because your blood sugar level should be neither high nor low.
- You might need to monitor your blood sugar carefully and more frequently—in some cases, before every meal and before and after sleep.
- Do not hesitate to ask your doctor about detailed instructions. Get them written down if needed.
- You will need to stop smoking and drinking.
On the day of the surgery
- On the day of the procedure, cross-check your morning medicine requirements.
- Do not go to the hospital alone, even if it is a minor procedure or a radiological investigation.
- Devices such as insulin pumps will fail when subjected to radiation (such as in X-rays, CT scans, and MRI scans). Inform the doctor about such devices for any such procedure.
- Avoid getting too stressed, as this may affect your blood glucose. Talk to your friends and family about anything you might be worried about.
- At the time discharge, ask the doctors for instructions regarding good postoperative care.
- You may not feel mild pain if you have diabetic neuropathy. Therefore, ensure that you check your wound for redness and swelling, as well as for pain on pressing the skin.
- If you have pain or redness around the wound and/or high fever, contact your doctor immediately.
What to expect from the healthcare professionals around the surgery.
- Your blood sugar may be monitored a lot more frequently than you are used to, depending on the outcome.
- Your anti-diabetic medicine may be switching to insulin before the procedure, usually until you are able to eat afterwards.
- You might get diabetic meals at the hospital as they will try to keep your blood glucose within a narrow target range to speed up recovery.
With adequate precautions, a person with diabetes can have a safe surgery with a speedy recovery. Ensure that you take blood sugar management seriously, and ask questions or seek clarifications wherever necessary.
- Australian Diabetes Society. Perioperative diabetes management guidelines. 2012.
- Sudhakaran S, Surani SR. Guidelines for perioperative management of the diabetic patient. Surgery research and practice. 2015.
- Loh-Trivedi M, Rothenberg DM, Schade DS, Schwer WA. Perioperative management of the diabetic patient. Medscape Online J. 2013.