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Diabetic patients have several things to think about when they undergo surgery, as there's a risk of complications. What should you know before you go under the knife?

Any surgical procedure carries certain risks, no matter how healthy you are. However, diabetics have additional concerns and should take some extra precautions when undergoing surgery.

Why is surgery risky for people with diabetes?

Surgery comes with a lot of stress for all patients, even those who are in good health. The physical and mental stress of surgery can actually cause significant changes in hormone levels, including the insulin. As diabetics already have either impaired insulin secretion or insulin resistance, they can experience even more intense fluctuations in insulin levels when undergoing surgery.

Therefore, it is highly recommended that diabetes patients who are planning to have surgery should achieve adequate control of their blood sugar levels. This is what can happen if your blood who levels are not properly controlled prior to your operation.

Hyperglycemia

High blood sugar levels can cause a myriad of post-operative complications. High blood sugar levels increase both the risk and severity of different complications.

Hypoglycemia

This refers to low blood sugar levels. Similar to hyperglycemia, hypoglycemia can significantly increase the risk of post-surgical complications.

Dehydration

Many diabetics experience frequent urination, particularly if their diabetes is not well-controlled. This can cause dehydration and increase the risk of potential complications.

Hyperglycemic hyperosmolar syndrome

Patients with diabetes can develop this dangerous condition in which they have high levels of glucose, dehydration, and reduced consciousness. This is a particularly relevant concern for diabetes patients who are undergoing certain surgical procedures such as a cardiac bypass surgery.

Diabetic ketoacidosis

Diabetic ketoacidosis is a condition in which patients produce toxic molecules called ketones. Patients with diabetes have an impaired ability to metabolize glucose, which is the primary source of energy for humans. When glucose can no longer be metabolized, the body starts to burn fats instead. However, that leads to the production of ketones as byproducts, which can build up in the blood and be life-threatening. Diabetic ketoacidosis is a complication that can develop in patients with diabetes who undergo surgery due to surges in the levels of insulin. This, again, highlights the importance of having well-controlled diabetes before surgery.

Slow wound healing

Diabetes leads to slow wound healing, so diabetics undergoing surgery may rightfully fear that they won’t be able to heal properly, leading to an increased risk of infection.

Infections

Diabetics have a higher risk of developing infections, partially due to slow wound healing, but also because patients tend to have nerve damage, a weakened immune system, and skin issues. Thus, they are more likely than a healthy person to get an infection post-surgery. In the same vein, diabetics are more likely to develop sepsis, a type of post-operative infection that develops due to bacteria in the bloodstream.

Endothelial dysfunction

Dysfunction of cells that line blood vessels, known as endothelial dysfunction. Patients with diabetes are more likely to have endothelial dysfunction, which means that they have an increased risk of blood vessel inflammation. This can affect blood clotting and the immune system, leading potential post-surgical complications.

Ischemia

Ischemia refers to a lack of blood supply to a specific part of the body, including the heart and brain. Diabetes patients are more likely to have ischemia, which is worsened in a post-surgical setting if blood glucose levels are not well controlled.

Kidney failure

Kidney disease is another risk, particularly in diabetics who have had high blood sugar levels for a long time. If patients experience any electrolyte imbalances, dehydration, high blood pressure or sepsis during surgery, that increases their risk of kidney failure.

Risk factors for post-surgical complications in type 2 diabetics

Certain factors exacerbate the risk of post-surgical complications for patients with type 2 diabetes. These include:

  • Age. The older you are when undergoing surgery, the higher your risk of complications.
  • Treatment regimen. Some diabetes treatment regimens are more likely to cause complications.
  • Diabetes management. The more well managed your diabetes is, the lower your risk of complications.
  • Pre-existing conditions. Some pre-existing conditions make people more prone to having complications.
  • Diet. Certain diets can cause complications post-surgically.
  • Duration of diabetes. The longer you have diabetes, the more likely you are to experience complications.
  • General fitness. The more in shape you are, the more likely you won’t experience complications.

So, how do you lower your risk of developing post-surgical complications?

The most important thing to remember if you are diabetic is that controlling your blood sugar levels and keeping them in the normal range is your best way to help prevent long-term complications. To prevent complications, you must follow certain guidelines such as:

  • Exercise more
  • Eat a healthier diet with high amount of protein and lower amount of carbohydrates
  • Lose weight
  • Stay adherent to your medication
  • Stay hydrated
  • Lower your stress levels (which can also be helped by working out)
  • Quit smoking
  • Limit your alcohol intake

When should I contact a doctor for a potential post-surgical complication?

You should contact a doctor or go to your emergency department if you experience:

  • Pus drainage from the surgical wound
  • Pain of the wound
  • Tenderness, swelling of the wound
  • Hardness or redness of the wound
  • Wound is hot to touch
  • You feel fatigued and have a fever

  • Staff, N. P., Engelstad, J., Klein, C. J., Amrami, K. K., Spinner, R. J., Dyck, P. J., ... & Dyck, P. J. B. (2010). Post-surgical inflammatory neuropathy. Brain, 133(10), 2866-2880.
  • Davis, B. L., Kuznicki, J., Praveen, S. S., & Sferra, J. J. (2004). Lower-extremity amputations in patients with diabetes: pre-and post-surgical decisions related to successful rehabilitation. Diabetes/metabolism research and reviews, 20, S45-50.
  • Shafi, M. A., & Pasricha, P. J. (2007). Post-surgical and obstructive gastroparesis. Current gastroenterology reports, 9(4), 280-285.
  • Photo courtesy of SteadyHealth

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