1. Health

Diabetes and Surgery: Post-Op Concerns

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Updated October 09, 2010

People with Type 2 diabetes have to worry about more than the normal risks and complications after an operation. Risks associated with diabetes and surgery are increased dependant on age, diabetes treatment regimen, level of control, existing complications or illness, malnutrition, length of time with diabetes, and general physical fitness.

The physical and mental stress of surgery can cause undesireable changes in hormone levels. These changes lead to increased insulin resistance, lower insulin secretion and less glucose uptake into cells. These increase the risk for hyperglycemia in a person with diabetes.

Post-Op Concerns

The following list of concerns illustrates the importance of having glucose levels in control prior to an operation:

  • Hyperglycemia or hypoglycemia: High or low glucose levels can cause post-operative complications, with high glucose levels topping the list. High levels increase the likelihood and severity of other complications. It is important to have glucose levels in good control prior to surgery.

  • Dehydration: The patient may have high urinary output if diabetes is under poor control with increased risk of osmotic diuresis. This can increase risk for other complications.

  • Hyperglycemic hyperosmolar syndrome (HHS): This is a situation where the patient has high glucose levels, dehydration, and decreased consciousness. It is of great concern following certain surgical procedures such as cardiac bypass surgery where it is associated with 42% mortality.

  • Diabetic ketoacidosis (DKA): Surgery and/or other complications can increase levels of stress hormones, making insulin less effective. If insulin cannot help the body burn glucose for energy, the body will burn fat instead. Toxic acid byproducts called ketones build up in the blood and can become life-threatening. Dehydration can accompany and sometimes cause DKA.

  • Impaired wound healing: People with diabetes are more likely to have poor circulation, nerve damage, weakened immune systems, and skin problems. These can slow wound healing and increase risk for infection.

  • Infection: The most common type of infection is incision infection. Risk is increased in people with diabetes due to slower healing time. It is important to take all medications as directed and follow incision care instructions.

  • Sepsis: A specific type of whole-body post-operative infection due to bacteria in the blood stream. It is severe and hard to control. Common origination sites after surgery are incisions, intravenous sites, drains, and skin ulcers.

  • Endothelial dysfunction: High glucose levels increase risk of inflammation or injury to the lining of blood vessels. Among other things, endothelial cells are associated with the transit of white blood cells, blood clotting, blood pressure, inflammation, and cardiovascular disease.

  • Ischemia: Lack of blood supply to a part of the body such as the heart, brain, skin or bowel leading to tissue death in the affected area. People with diabetes are at higher risk, particularly if they have out-of-control glucose levels. Gastrointestinal upset and dehydration increases risk.

  • Electrolyte imbalance: Nausea, vomiting and dehydration can be caused by stress, medications and anesthesia resulting in imbalanced blood salts. This can increase risk for for heart arrhythmias and renal failure. The risk is compounded in diabetics who are already at higher risk for coronary and renal problems.

  • Renal failure: Diabetes is the most common single cause of renal failure. Risk during or after surgery can be increased by causes such as electrolyte imbalance, dehydration, medication reactions, abnormal blood pressure, sepsis and trauma.

  • Heart arrhythmias: Risk increases with uncontrolled diabetes, heart disease, certain medications, hypertension, obesity, and electrolyte imbalance.

Lower Your Risks

  • Get and maintain blood glucose levels within target ranges

  • Exercise to improve your physical fitness

  • Get good nutrition with sufficient high-quality protein

  • Avoid dehydration

  • Take measures to lower stress

  • Don't smoke or drink alcohol

Watch for Signs of Infection and Wound Complications

Notify your physician immediately if you have any of these symptoms

  • Purulent drainage

  • Localized pain, tenderness, swelling, hardness, redness, or heat.

  • Fever




Sources:

Dagogo-Jack, MD, FRCP, Samuel and Alberti DPHIL PRCP, K. George MM. "Management of Diabetes Mellitus in Surgical Patients." Diabetes Spectrum January 2002 15(1): 44-48

Mangram MD, Alicia; Horan MPH CIC, Teresa; Pearson MD, Michelle L; Silver BS, Leah Christine; and Jarvis MD, William R. "Guideline for Prevention of Surgical Site Infection 1999" Infection Control and Hospital Epidemiology 20(4):247-278

Rosenberg, CS. "Wound healing in the patient with diabetes mellitus." The Nursing Clinics of North America Mar 25 1990 25(1):247-61.

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