How Serious is Diabetes ?

Diabetes Control During Surgery

As many as one-half, of 16 million Americans having diabetes, undergo surgery at some time in their lives. You and your health care team may have to brave several changes after the surgery. The psychological strain can cause variation in blood glucose, delaying wound healing and increasing incidence of infection.

Fasting and the insulin received before surgery will increase risk of hypoglycemia unless dextrose, a form of sugar is added to the iv fluids. The blood sugars elevate during this period due to the hormonal changes.

Levels of stress hormones remain high throughout most surgical procedures because of anesthesia. This stress response, in turn, causes blood sugars to continue to rise. Large amounts of dextrose containing fluids are given to prevent dehydration and to allow medications to be easily administered during the surgery. This too, if not treated, causes high blood glucose.

Insulin is relatively easy to adjust with changes in the blood sugar. To control blood sugar levels, it is often imperative to take insulin before, during and even after surgery. Even someone following a good diet and oral medication may need insulin to control the blood sugars during periods of stress, such as surgery. Treatment with insulin during surgery is usually temporary, unless you are already taking insulin for diabetes management. You may no longer need insulin, once you are out of the anxiety state due to stress.

The major effect of diabetes after surgery is related to variable food intake and ability to take fluids. There is a risk of both low and high blood glucose due to the uncertainty of when you will be able to tolerate a meal without nausea and vomiting.

Insulin for surgery is needed for all Type 1 patients and Type 2 patients who are already on insulin therapy or on oral agent therapy but with elevated HbA1c levels (poor control). Extended NPO (no food or beverages) status after surgery also needs to take insulin.

It is not necessarily indicated for Type 2 patients who have a well-controlled with diet or oral agent, near normal HbA1c, fasting blood glucose on day of surgery is 120-180mg/dl, if estimated length of surgery is less than two hours and if use of iv glucose solutions is not expected.

Surgery should be scheduled as early in the day as possible.