MEDICALLY SPEAKING: Caution, planning required prior to surgery for people with diabetes
Considering the special risks, people who have diabetes must take extra precautions when preparing for surgery, says Doreen Lewis, RN, the diabetic educator on staff at SSM St. Joseph Hospital West.
"If surgery is planned in advance, the first step is to make sure your blood sugar is under control in the days leading up to the procedure," she says.Preventing a high or low blood sugar attack during surgery is very important, and well-controlled sugar levels may speed recovery.
"Many people find their blood sugar is closest to optimal first thing in the morning, and because you usually can't eat for at least six hours prior to surgery, waiting until later in the day can be problematic," Doreen says.
She recommends patients ask that their surgery be scheduled first thing in the morning.
Another preparatory activity involves discussing your pre-surgical medication plan with your endocrinologist or the primary-care physician who oversees your diabetes management. In some cases, a patient's usual insulin dose should be altered just prior to surgery.
"Your doctor and surgeon should clearly communicate," Doreen adds. "The entire surgical team should plan with your condition in mind. It's crucial that your surgeon talk with your regular diabetes management team to ensure that all your individual needs are taken into consideration."
Another important member of the surgical team is the anesthesiologist. He or she should be made aware of your condition and any diabetic complications you may have. Anesthesiologists consider patients' diabetes history when planning the anesthesia regimen, Doreen says. Typically, anesthesiologists check blood sugar levels during surgery, and an intravenous line may be inserted to administer fluids and dextrose, if needed, during the procedure.
After surgery, patients with diabetes are carefully monitored, and insulin is administered as needed. Some potential post-surgical medication changes can be anticipated, so ask your surgeon about plans for handling your medication immediately following the procedure and during your convalescence.
Because Doreen works closely with many patients who have diabetes, providing information and answering questions, she is an excellent resource for anyone with diabetes who plans to have surgery at SSM St. Joseph Hospital West.
In fact, Doreen meets with adult diabetes patients and their caregivers every third Tuesday of the month to answer questions and share advice. She also works with patients newly diagnosed with diabetes to help them understand how to manage their disease and make the best lifestyle choices to help ensure their health and well being. Call 636-625-5447 for more information about the adult diabetes support group or the diabetes self-management training program.
"Patients who have diabetes should always be sure they communicate clearly with their health care providers about the surgery, its benefits and risks, then make the decisions that are right for them," she says.
And I think that's good advice for everyone.
Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and has achieved fellowship status in the American College of Emergency Physicians and the American College of Osteopathic Emergency Physicians.
