Diabetic Considerations Before, During And After Surgery
March 22, 2007 by Kendra James, RN
Filed under Diseases & Conditions
My Mom had a knee replacement 2 days ago. All is well, she did just fine and the surgery was a success. You would have thought by the way she was acting it was bypass surgery, her anxiety was through the roof. Leading up to today she had a list of many questions that she had formulated. From how many pairs of underwear did she need to when will the catheter be taken out. Yes, that was her main worry. Not the titanium rod going into her femur or the fact that she was at risk being a diabetic, but a foley catheter.
My Mom is a type 2 diabetic, diagnosed 2 years ago. She controls her diabetes by diet and exercise and has dropped 50 pounds in the last year and a half. Her original surgery time was for 1 PM. This was concerning.
Try to get the first morning time slot in the operating room. There will be less of a chance for high or low blood sugar reactions while you are waiting for your operation and are unable to eat.
After she contacted her doctors office to ever so gently, hahaha, remind them of being a diabetic, they changed her surgery time to 8 AM. Much better. My next concern was how her blood sugar would be affected both during and immediately following surgery. Surgery is very stressful on the body, which can cause either a quick rise in blood sugar, or a sharp drop if the diabetic is dependent on insulin. Fortunately, my mom has me. A loud mouthed, opinionated nurse for a daughter. Others who are not so lucky, haha, need to take matters into their own hands and be their own patient advocate before surgery. You are not being pushy, just safe!
Talk to your anesthesiologist- This is the doctor who is responsible for monitoring your diabetes while your surgeon is performing the operation. Tell the anesthesiologist about your medical history, including details about your diabetes. Be sure to include your current medication regimen and any diabetes-related complications you have.
Following surgery, one of the biggest complications among diabetics is wound healing and infection. As a nurse, I am always concerned with keeping a post surgical, diabetic patient’s blood sugar between normal limits. Promoting good blood flow and proper dietary habits to allow for optimal incisional healing is also important.
Underlying systemic disease in a patient with a wound can dramatically diminish the probability that the wound will heal in a timely fashion. Diabetes mellitus is a classic example. Wound healing is often delayed because of interruption of the inflammatory and proliferative phases. Infection thus prolongs the inflammatory phase. When erythrocytes are affected by glycosylation (as measured by hemoglobin A1c levels), they become less pliable, leading to microvascular sludging and ischemia. Low tissue oxygen tension impairs cellular proliferation and collagen synthesis as previously described.
Does that sound like blah, blah, blah? In plain English, a diabetics vascular system is compromised due to narrowing of blood vessels. Poor blood flow leads to infection. See, that wasn’t so hard.
My last piece of advice is be willing to make changes. Like mentioned above, surgery is very taxing on a diabetics body. Medications, diet and insulin regimens may have to be adjusted to promote the best healing possible.
After surgery, you may need to adjust your medication or insulin doses based on your blood sugar level. Ask your doctor how you should manage your diabetes so that you can prepare in advance.
Surgery is scary. Diabetes is a disease that you live with everyday. Be loud. Be obnoxious. Be whatever you have to in order to get all the questions you have answered. If you have specific concerns related to your diabetes, ask away. And if the doctor dismisses any of them, find a new doctor!
