Diabetes Control Matters

Surgery And Your Diabetes

Approximately 16 million Americans have diabetes, and as many as one-half of them will require surgery at some time in their lives. Surgery presents several challenges for both you and your healthcare team. Stress and anxiety can cause fluctuations in blood glucose, delaying wound healing and increasing incidence of infection.

Before Surgery

You are fasting, usually have an IV, and are anxious. If you have received insulin, fasting will increase the risk of hypoglycemia (low blood sugar) unless dextrose (a form or sugar) is added to the IV fluids to protect against hypoglycemia. During this time there are also hormonal changes which cause the blood sugars to rise.

During Surgery

As you are given anesthesia, levels of stress hormones continue to rise, remaining high throughout most surgical procedures. This stress response causes blood sugars to continue to rise. Large amounts of dextrose-containing fluids are also usually given to prevent dehydration and to allow medications to be easily administered during surgery. This continues to cause blood glucose to become elevated, if untreated.

In order to prevent blood sugars from going too high, it is often necessary to give you insulin before, during and even after surgery. Because insulin is relatively easy to adjust with changes in the blood sugar, even someone well controlled on diet or 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. When the stress is over, you may no longer need insulin.

After Surgery

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.

Will You Need Insulin For Surgery?

Indicated for:

• All Type 1 patients
• Type 2 patients
• Already on insulin therapy
• On oral agent therapy but with elevated HbA1c levels (poor control)
• Extended NOP (no food or beverages) status after surgery.

Not Necessarily Indicated For:

• Type 2 patients
• Well-controlled with diet or oral agent
• Near normal HbA1c
• Fasting blood glucose on day of surgery <180mg/dl
• Estimated length of surgery <2hours
• Use of IV glucose solutions not expected

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