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Is It Dangerous For Diabetics To Have Surgery?

Diabetes And Surgery

Diabetes And Surgery

Here’s a question I’ve always wondered about: what are people with diabetes supposed to do if they have to have surgery? Not only does the trauma of having someone cut into your body seem like it would send your blood sugar sky high, but what are you actually supposed to do in the operating room? How should you prepare? What precautions should you take? And what adjustments do you need to make during your recovery? I recently had the chance to find out all this and more when I had arthroscopic surgery on my right shoulder for a SLAP tear. In non-medical terms, I ripped a piece of cartilage off of part of the bone of my shoulder joint, and I needed to have a surgeon go in and reattach it. It’s an injury really common among professional baseball pitchers. I, on the other hand, did mine while stretching. Today marks three weeks from the date of surgery (and my first day out of my sling!) and I thought I’d take advantage of my newly limber right arm to make a list of suggestions and observations that others might find useful. So here goes: 1. Several weeks before your surgery, ask your surgeon if s/he will need you to do any additional medical tests beforehand. For example, I had to get an EKG and a blood panel done two weeks before my surgery and have the results faxed in to my surgeon’s office in order to get clearance for the surgery to be done. If they hadn’t received these test results, the surgery would have been cancelled. Which leads me to my next suggestion: 2. Do not forget to get these tests done. Not that I almost did, leading to the surgeon’s assistant leaving me desperate voicemails as I celebrated my best friend’s wedding in California, far away from my insurance company’s approved provider network. No, I’d never do that. 3. If your surgeo Continue reading >>

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric surgery may not only help people combat obesity: Evidence shows it can also help reduce diabetes risk factors. A new University of Minnesota study published in JAMA on June 5 reveals that mild to moderately obese patients with Type 2 diabetes had more improvements in their blood glucose, cholesterol and blood pressure after they underwent gastric bypass surgery, than patients who made lifestyle changes with medical counseling. About 35.7 percent of the U.S. adult population is obese, according to the Centers for Disease Control and Prevention. Obesity has been linked to heart disease, stroke, Type 2 diabetes, some cancers and some of the leading causes of preventable death. About 25.8 million people have diabetes in the U.S. as of 2010, the NIH reports. The vast majority of those people have Type 2 diabetes, which is when the body does not produce enough insulin or the cells do not use the insulin. Insulin is produced by the pancreas and is required for a process in which the body wants to use energy from glucose, or broken down sugars and starches obtained from food. The best treatment for Type 2 diabetes is weight loss, but controlling glucose levels, blood pressure and cholesterol are important as well, the study authors noted. However, the optimal way to manage all those factors remains unknown. Researchers looked at 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0 percent or higher, body mass index (BMI) between 30.0 and 39.9 signifying they were obese, a C peptide level of more than 1.0 ng/mL, and Type 2 diabetes for at least six months. The subjects were divided into two groups and followed for a year. The first group underwent Roux-en-Y gastric bypass. The second group was instructed to change their lifestyle and have intensive medical mana Continue reading >>

Hyperglycemia In The Hospital

Hyperglycemia In The Hospital

Hyperglycemia is the medical term for blood glucose (sugar) that is too high. High blood glucose (HBG) is a common problem for people with diabetes. Blood glucose can also rise too high for patients in the hospital, even if they do not have diabetes. This patient guide explains why some patients develop HBG when they are hospitalized and how their HBG is treated. Until about 10 years ago, doctors thought that HBG in hospital patients was not harmful as long as their blood sugar stayed at or below 200 milligrams per deciliter (mg/dL). Recent research studies show that HBG above 180 increases the risk of complications in hospital patients. Keeping blood sugar below this level with insulin treatment lowers the risk for these problems. Most doctors agree that controlling blood sugar so it stays below 180 mg/dl is best for very ill patients in intensive care units ( ICU). Less clear is what the best target blood sugar should be for inpatients who are admitted for general surgery or non-critical medical conditions. In some patients, insulin treatment can cause low blood sugar, called hypoglycemia. Just like blood sugar levels that are too high, blood sugars that are too low are not safe and should be avoided. This patient guide for glucose control in the hospital is based on The Endocrine Society’s practice guideline for health care providers on preventing and treating HBG. This guide applies just to patients on a regular hospital floor, not those who are in an ICU. What causes HBG in the hospital? Many conditions can cause or worsen HBG in hospital patients. These include: Physical stress of illness, trauma, or surgery Inability to move around Steroids like prednisone and some other medicines Skipping diabetes medicines Liquid food given through a feeding tube or nutrition Continue reading >>

Bariatric Surgery For Diabetes

Bariatric Surgery For Diabetes

New guidelines last week recommended surgery as Type 2 diabetes treatment for people who are obese, including some who are mildly obese. Is “metabolic surgery” something you should consider? The guidelines were approved by the American Diabetes Association, the International Diabetes Federation, and 43 other medical groups around the world. They were published in the June issue of the journal Diabetes Care. If you are heavy and have an HbA1c of 7.0 or above, your doctor may soon advise you to have one of these surgeries. You will be told the surgery will lower your blood sugar and your weight, which usually happens. You may not be told the negative effects. How do you decide? When performed to manage diabetes, bariatric or weight-loss surgery is known as “metabolic surgery.” The term covers Roux-en-Y “gastric bypass” surgeries, which reduce your stomach to a small pouch and plug it into the middle of the small intestine. It also includes “sleeve gastrectomy,” in which the deep part of the stomach is removed and the rest stapled together into a sleeve shape. Wrapping a band around the stomach to shrink it (“gastric banding“) is also now considered metabolic surgery. There are other surgeries that restructure the bowel in different ways, which I’ll write about next week. Surgeons have been pleased to learn that their weight-loss operations also lower blood sugars, though they are working to fully understand how that happens. It’s probably not the weight loss. Often, the improvements in diabetes numbers come long before significant weight loss occurs. A conference in Rome in 2007 reported that people were getting off their diabetes medications and lowering their HbA1c scores after surgery. Eight years later, a follow-up conference in London decided Continue reading >>

Prophylactic Foot Surgery In Patients With Diabetes: Is It Worth The Risk?

Prophylactic Foot Surgery In Patients With Diabetes: Is It Worth The Risk?

Lower extremity complications associated with diabetes present a special challenge to any physician contemplating surgical management. Prophylactic foot surgery can be described as a procedure to prevent ulceration or re-ulceration in patients with diabetes without significant vascular compromise. This concept is part of a larger classification system, which stratifies the risks associated with various types of foot surgery.1 Why and when would you consider prophylactic surgery? A history of previous ulceration and/or amputation is an important consideration when assessing a patient for prophylactic surgery.2 Patients with diabetes are clearly at a higher risk for non-traumatic lower extremity amputation if they exhibit peripheral neuropathy, structural deformity, vascular disease, ulceration and infection.3 Patients with peripheral neuropathy and structural deformity without critical limb ischemia may be candidates for prophylactic intervention. The annual incidence of diabetic ulceration is between 5 and 7.5 percent when neuropathy is present.4 Peripheral neuropathy and mechanical stress play central roles in diabetic foot ulcerations. Components of distal symmetric polyneuropathy include sensory and motor neuropathy. Motor neuropathy may lead to bony deformities such as hammertoes with areas of high pressure. When combined with limited joint mobility, these areas can eventually become pre-ulcerative sites with the potential for skin breakdown. Patients are unable to detect any discomfort in these areas due to the loss of protective sensation. As a result, repetitive pressure leads to local ischemic necrosis.4,5 Although researchers have shown that therapeutic shoes can be effective in reducing the recurrence rates of ulcers in patients with diabetes, these rates can Continue reading >>

Fasting For Surgery: What If I Have A Low?

Fasting For Surgery: What If I Have A Low?

I have diabetes and will be getting an operation. I am not supposed to eat or drink after midnight, but after four hours, my blood glucose drops. What can I take to bring it up? Continue reading >>

Diabetes And Its Negative Impact On Outcomes In Orthopaedic Surgery

Diabetes And Its Negative Impact On Outcomes In Orthopaedic Surgery

Go to: PATHOPHYSIOLOGY Diabetes mellitus can be broadly classified into three types, based on the onset of symptoms and the absolute need for insulin replacement. Patients who have an absolute requirement for insulin, secondary to autoimmune dysfunction of the pancreatic beta cells, have type 1 DM. The vast majority of patients have type 2 DM which is associated with older patients, elevated body mass index (BMI), genetic predisposition, history of DM during pregnancy, less active individuals, and certain ethnic groups. Four out five patients with type 2 DM have an elevated BMI. Children and adolescents, particularly from certain ethnic and racial groups (African - American, Mexican American, and Pacific Islander), are being diagnosed with type 2 DM at an increasing rate. During the early stages of type 2 DM the pancreas usually produces insulin, however insulin resistance is present and glucose metabolism is negatively impacted. A small percentage of pregnant women develop gestational DM and 40% to 60% of these patients will ultimately develop type 2 DM within 5 to 10 years. The end result of DM, regardless of the etiology, is hyperglycemia. The primary energy source for our body is glucose, and glucose is stored as glycogen in the liver and skeletal muscle. Insulin facilitates glucose uptake into the peripheral cells, assisting with the storage of glycogen. While patients with type 1 DM have an absolute need for insulin replacement, patients with type 2 DM initially produce insulin, sometimes in high amounts. The problem is so called “insulin resistance”, in which the cells become less sensitive to insulin and hyperglycemia results. Stress hyperglycemia can occur in hospitalized patients without a previous history of DM and is defined as any serum glucose > 140 mg Continue reading >>

What Diabetics Need To Know Before Plastic Surgery

What Diabetics Need To Know Before Plastic Surgery

Is your diabetes stopping you from considering a brow lift or facelift? If you are concerned about the effect your condition will have on the surgery’s results, like anyone you should do your research first. While diabetics do have an increased risk of complications from any type of surgical procedure, having diabetes doesn’t necessarily mean plastic surgery is off the table. Your surgeon can work with you to reduce your risks. Risks of Surgery One of the biggest risks for diabetics having surgery is that high blood sugar levels interfere with your body’s ability to heal. A study published in October 2013 in the journal "Plastic and Reconstructive Surgery" found that patients with very high blood sugar (over 200) were more likely to have complications in their surgical wounds after having surgery to correct wounds related to their condition. An occurrence known as wound dehiscence, which happens when the surgical incision re-opens after the procedure, took place in 44 percent of patients who had blood sugar levels above 200. A normal blood sugar level is 100, or 140 if tested after eating. Just 19 percent of patients with normal blood sugar levels before surgery had wound dehiscence, according to the study. Having elevated hemoglobin A1c levels also increased a patient’s risk for wound dehiscence. High A1c levels suggest that a patient has had difficulty managing his or her diabetes. The issue with wounds reopening after surgery was three times more likely to occur in patients with elevated A1c levels. The Effect of Surgery on Blood Sugar Levels Stress on the body can affect blood sugar levels. During periods of high stress, the body is more likely to produce more blood glucose. Surgery, whether it’s a facelift or a life-saving procedure, causes physical stres Continue reading >>

Diabetes And Surgery - How To Improve Your Chance Of A Great Outcome

Diabetes And Surgery - How To Improve Your Chance Of A Great Outcome

The Risks of Surgery In addition to the normal Risks of Surgery, diabetics face additional risks when having a surgical procedure. These risks are heightened if you have had diabetes for an extended period of time, frequently have high blood sugars, or if you are a brittle (have difficulty controlling your glucose level) diabetic. Patients who have already experienced major complications from diabetes, such as neuropathy or requiring an amputation are also at higher risk. The Risks Diabetics Face After Surgery: Hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose) Poor wound healing, slow wound healing, weak skin and tissue at site of surgery Infection, including infection of the wound, pneumonia, urinary tract infection or sepsis Electrolyte Imbalance-A condition where electrolyte levels (sodium, potassium) rise or fall significantly, which can cause significant problems with the heart and the body’s fluid levels. What Diabetics Can Do to Be a Better Surgical Candidate The better your control of your diabetes, the better your chances of an excellent surgical outcome. Keeping your blood glucose within the parameters your doctor recommends is key. Top-notch nutrition, including high-quality protein, is also essential. Protein is an important component in the healing process and can help contribute to faster wound healing, stronger tissue at the surgical site and an increased ability to withstand the rigors of surgery. If you aren’t already exercising but you are able, you may want to start an exercise program after checking with your doctor. Making your body stronger is going to help you better tolerate your surgery and recovery. Try not to get overly stressed about your surgery. If you are feeling anxious about your surgery, Coping with surgical fea Continue reading >>

Diabetes And Joint Replacement Surgery 101

Diabetes And Joint Replacement Surgery 101

If you’re living with diabetes, you know better than anyone that your rulebook for general health is different than most. To add another layer to your health management puzzle, chances are you’ve found this post because you’re a diabetic preparing for a hip replacement or knee replacement or are trying to decide when the right time for a joint replacement is. With this, know that joint replacement surgery is one of the most successful procedures in all of modern medicine and that you have the power to further reduce your risk factors. What you do in the weeks leading up to your hip replacement or knee replacement will have a huge impact on your surgery results and recovery time. This is especially true for those with pre-existing conditions like diabetes. Taking action before surgery in a results-driven program is called “PreHab”. Read on as we talk about how diabetes can affect joint replacement surgery, examine surgical complications for those with diabetes, and offer some prehab diet suggestions to optimize your health before due day. How Can My Diabetes Affect Joint Replacement Surgery? Diabetes (especially when uncontrolled or paired with a related disease) greatly affects recovery time from joint replacement surgery. Those with diabetes are at a greater risk for infection, slower wound and incision repair, as well as a laundry list of secondary complications. Uncontrolled Diabetes: Blood sugar levels that are too high (240 and over or consistently outside of optimal zone) is often due to improper diet, lack of exercise, inconsistent medication use and other factors. The risks associated with uncontrolled diabetes include: heart disease, kidney disease, eye damage, neuropathy, amputations, dental issues and more. Controlled Diabetes: Blood sugar levels ma Continue reading >>

Metabolic And Bariatric Surgery And Type 2 Diabetes

Metabolic And Bariatric Surgery And Type 2 Diabetes

Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>

Preparing For Surgery When You Have Diabetes

Preparing For Surgery When You Have Diabetes

Work with your health care provider to come up with the safest surgery plan for you. Focus more on controlling your diabetes during the days to weeks before surgery. Your provider will do a medical exam and talk to you about your health. Tell your provider about all the medicines you are taking. If you take metformin, talk to your provider about stopping it. Sometimes, it can be stopped 48 hours before and 48 hours after surgery to decrease the risk of a problem called lactic acidosis. If you take other types of diabetes drugs, follow your provider's instructions if you need to stop the drug before surgery. If you take insulin, ask your provider what dose you should take the night before or the day of your surgery. Your provider may have you meet with a dietitian, or give you a specific meal and activity plan to try to make sure your blood sugar is well-controlled for the week prior to your surgery. Some surgeons will cancel or delay surgery if your blood sugar is high when you arrive at the hospital for your surgery. Surgery is riskier if you have diabetes complications. So talk to your provider about your diabetes control and any complications you have from diabetes. Tell your provider about any problems you have with your heart, kidneys, or eyes, or if you have loss of feeling in your feet. The provider may run some tests to check the status of those problems. You may do better with surgery and get better faster if your blood sugar is controlled during surgery. So, before surgery, talk to your provider about your blood sugar target level during the days before your operation. During surgery, insulin is given by the anesthesiologist. You will meet with this doctor before surgery to discuss the plan to control your blood sugar during the operation. You or your nurses s Continue reading >>

How Diabetes Affects Wound Healing

How Diabetes Affects Wound Healing

Diabetes is a condition in which the body does not effectively use sugar. It is estimated that there are nearly 18 million Americans with diabetes, and approximately 15 percent of diabetics will develop a foot ulcer at some point. Foot ulcers are the most common wounds for this patient population. Wound healing can be slowed when the patient is diabetic. An important point to remember about a diabetic patient wound is that it heals slowly and can worsen rapidly, so requires close monitoring. There are several factors that influence wound healing in a diabetic patient, and may include: Blood Glucose Levels It all starts here. An elevated blood sugar level stiffens the arteries and causes narrowing of the blood vessels. The effects of this are far-reaching and include the origin of wounds as well as risk factors to proper wound healing. Poor Circulation Narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly. Diabetic Neuropathy When blood glucose levels are uncontrolled, nerves in the body are affected and patients can develop a loss of sensation. This is called diabetic neuropathy. When there is a loss of sensation, patients cannot feel a developing blister, infection or surgical wound problem. Because a diabetic patient may not be able to feel a change in the status of a wound or the actual wound, the severity can progress and there may be complications with healing. Immune System Deficiency Diabetes lowers the efficiency of the immune system, the body's defense system against infection. A high glucose level ca Continue reading >>

Safe Surgery With Diabetes

Safe Surgery With Diabetes

If your doctor is honest he or she will have told you that people with diabetes have a very high risk of developing a serious infection or other complication after surgery. But having diabetes also makes it likely that a person will need surgery. So with that in mind let's look at what you can do if you are a person with diabetes to make sure that you emerge safely from any surgery you might have to undergo. 1. People with Diabetes and Normal Blood Sugar Fare as Well as Normal People. I can't point you to a study that proves this, because, sadly, there are no studies that involve people diagnosed with diabetes who maintain normal blood sugars. The only data we have is anecdotal--i.e. reports of people who have normalized their blood sugar despite a diabetes diagnosis. And the news from them is very good. This makes sense. There are two reasons that people with diabetes have such poor outcomes in a surgical setting. One is because uncontrolled high blood pressure destroy the tiny capillaries that should bring immune cells to healing tissues, which allow bacteria to grow unopposed. The other thing high blood sugars do is destroy nerves. Early in the process these high blood sugars kill the smaller nerve, then then later on, the larger nerves. This has a huge impact on the body's ability to fight infection because we now know thanks to Kevin Tracy's ground breaking research about the immune system published in Nature in 2002 that the nerves play a major role in sensing and then triggering the immune response to invasion. So when the nerves are damaged by high blood sugars, the immune system may not learn that an infection is taking place. This may be a major reason why neuropathy leads to the uncontrollable infections that lead to amputation. But if you keep your blood sug Continue reading >>

Spine Surgery And The Risks Faced By Diabetic Patients

Spine Surgery And The Risks Faced By Diabetic Patients

At Frisco Spine, we proudly offer a full range of surgical spine treatment options to patients who are seeking relief from debilitating back, neck, leg, joint, and other types of pain. While the skill and experience of our surgeons and the exceptional safety profile of our advanced surgical techniques help to minimize the risk of post-surgical complications, it must be understood that no surgery is without risks. Even the most minimally invasive surgeries have associated risks. During consultations, we make sure to detail these risks to patients so that they can make educated, informed decisions about whether to proceed with surgery. We are also extremely careful to evaluate patients prior to surgery to ensure their candidacy for a given procedure. In most cases, we recommend non-surgical treatments before recommending surgery; however, this is particularly true when patients have conditions that put them at higher risk of complications if they undergo a surgical procedure. For example, diabetics are inherently more likely to suffer post-surgical complications by nature of their disease, and even more so if their blood glucose levels are not well controlled. We explain the connection between spine surgery and diabetes during consultations at our Frisco, TX spine center so that diabetic patients understand the risks of surgery. If you have diabetes and want to discuss your spine surgery options, please schedule your initial consultation at Frisco Spine today. What Risks Do Diabetic Patients Face When Undergoing Spine Surgery? In general, diabetic patients tend to have greater difficulty healing than non-diabetic patients, which can make the recovery period more difficult. However, they also face a number of specific risks, which can vary from patient to patient and are g Continue reading >>

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