High Blood Sugar Can Increase Post-surgery Wound Complications
High blood glucose levels can lead to wound infection. Diabetes is a disease that can not only lead to serious issues like amputation, but can also affect the way your body handles the wound healing process. Researchers have recently analyzed how maintaining a high blood sugar level could eventually lead to an increase in wound complications after undergoing a surgical procedure. Members of the American Society of Plastic Surgeons analyzed the rates of 79 patients who had endured wound-related complications after receiving surgery to close up chronic wounds. The doctors measured the blood glucose levels of the patients five days leading up to the medical procedure as well as five days after, and extensively tested the subjects for measurements of hemoglobin A1c, which is a primary indicator of long-term diabetes control in the body. High levels of blood glucose as well as diabetes control are the main risk factors that can influence an occurrence of wound infection, additional surgery and wound dehiscence, which is when a wound is re-opened after already receiving surgery to close it. Blood glucose levels that are considered higher than average are measured at 200 milligrams per deciliter or greater. The researchers found that 44 percent of the patients who exhibited high blood glucose levels either before or after surgery underwent experiences of wound dehiscence, while only 19 percent of diabetic patients who had normal blood glucose levels received any type of wound complication. The records of those who had high hemoglobin A1c levels, which are primary indicators of poor diabetes control, also showed significant spikes in the rates of wound infection or re-opening occurring. Dr. Christopher Attinger, a professor at Georgetown University as well as one of the lead st Continue reading >>
Management Of Diabetes Mellitus In Surgical Patients
Abstract In Brief Diabetes is associated with increased requirement for surgical procedures and increased postoperative morbidity and mortality. The stress response to surgery and the resultant hyperglycemia, osmotic diuresis, and hypoinsulinemia can lead to perioperative ketoacidosis or hyperosmolar syndrome. Hyperglycemia impairs leukocyte function and wound healing. The management goal is to optimize metabolic control through close monitoring, adequate fluid and caloric repletion, and judicious use of insulin. Patients with diabetes undergo surgical procedures at a higher rate than do nondiabetic people.1,2 Major surgical operations require a period of fasting during which oral antidiabetic medications cannot be used. The stress of surgery itself results in metabolic perturbations that alter glucose homeostasis, and persistent hyperglycemia is a risk factor for endothelial dysfunction,3 postoperative sepsis,4 impaired wound healing,5,6 and cerebral ischemia.7 The stress response itself may precipitate diabetic crises (diabetic ketoacidosis [DKA], hyperglycemic hyperosmolar syndrome [HHS]) during surgery or postoperatively, with negative prognostic consequences.8,9 HHS is a well known postoperative complication following certain procedures, including cardiac bypass surgery, where it is associated with 42% mortality.9,10 Furthermore, gastrointestinal instability provoked by anesthesia, medications, and stress-related vagal overlay can lead to nausea, vomiting, and dehydration. This compounds the volume contraction that may already be present from the osmotic diuresis induced by hyperglycemia, thereby increasing the risk for ischemic events and acute renal failure. Subtle to gross deficits in key electrolytes (principally potassium, but also magnesium) may pose an arrhy Continue reading >>
Hyperglycemia After Surgery: Danger Depends On Diabetes Status
Patients with elevated blood sugar after heart surgery may need treatment tailored to their initial diabetes status. That’s the finding of a new study by researchers in Mount Sinai Hospital in New York. The team analyzed the clinical and economic outcomes in 4,316 patients with hyperglycemia after heart surgery, stratified by diabetes status. “The management of post-operative hyperglycemia is controversial and generally does not take into account pre-existing diabetes,” wrote Giampaolo Greco, PhD, MPH, in an article published online in the January 29 issue of Diabetes Care. Greco is an Assistant Professor in the department of Population Health Science & Policy at Mount Sinai. The team compared cost, length of stay, cardiac and respiratory complications, major infections, and death in patients undergoing cardiac surgery who had either no diabetes, insulin-treated diabetes, or non-insulin-treated type 2 diabetes. In addition, the patients, who were all enrolled in a multi-center cohort trial, had their glucose levels measured at 6-hour intervals for 2 days after surgery. They found that patients who did not have diabetes had worse outcomes when they had elevated glucose levels after surgery. Having glucose levels greater than 180 mg/dL was associated Levels greater than 180 mg/dL were associated with an additional cost of $3,192, 0.8 days longer in the hospital, 1.6% increased infections, and 2.6% increased respiratory complications, similar to patients who already had non-insulin-treated type 2 diabetes with post-surgery hyperglycemia. On the other hand, among patients with insulin-treated diabetes, the best outcomes actually came with blood glucose levels between 180 and 240 mg/dL. These outcomes were associated with $6,225 in cost reductions, 1.6 fewer days in th Continue reading >>
High Blood Glucose: What It Means And How To Treat It
What is high blood glucose? People who do not have diabetes typically have fasting plasma blood glucose levels that run under 100 mg/dl. Your physician will define for you what your target blood glucose should be — identifying a blood glucose target that is as close to normal as possible that you can safely achieve given your overall medical health. In general, high blood glucose, also called 'hyperglycemia', is considered "high" when it is 160 mg/dl or above your individual blood glucose target. Be sure to ask your healthcare provider what he or she thinks is a safe target for you for blood glucose before and after meals. If your blood glucose runs high for long periods of time, this can pose significant problems for you long-term — increased risk of complications, such as eye disease, kidney disease, heart attacks and strokes and more. High blood glucose can pose health problems in the short-term as well. Your treatment plan may need adjustment if the blood glucose stays over 180 mg/dl for 3 days in a row. It is important to aim to keep your blood glucose under control, and treat hyperglycemia when it occurs. What are the symptoms of high blood glucose? Increased thirst Increased urination Dry mouth or skin Tiredness or fatigue Blurred vision More frequent infections Slow healing cuts and sores Unexplained weight loss What causes high blood glucose? Too much food Too little exercise or physical activity Skipped or not enough diabetes pills or insulin Insulin that has spoiled after being exposed to extreme heat or freezing cold Stress, illness, infection, injury or surgery A blood glucose meter that is not reading accurately What should you do for high blood glucose? Be sure to drink plenty of water. It is recommended to drink a minimum of 8 glasses each day. If yo Continue reading >>
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Hyperglycemia And Perioperative Glucose Management
Go to: ADVERSE AFFECTS OF HYPERGLYCEMIA Patients who experience major trauma, illness, or surgery often develop a hypermetabolic stress response, which is characterized by hyperglycemia and insulin resistance. This response involves an increased level of endogenous hepatic glucose production while insulin-stimulated peripheral glucose uptake is reduced. This hyperglycemic response has been referred to as “stress hyperglycemia”. Initially, this response was considered to be a beneficial adaptation to critical illness because an additional glucose supply was available as a source of energy. However, an increasing body of evidence indicates that acute severe hyperglycemia causes numerous immediate adverse effects and is associated with serious adverse clinical outcomes. Hyperglycemia is common during major surgery because of the hypermetabolic stress response. The severity of the hyperglycemic response to major surgery may be affected by an individual's ability to control blood glucose [13] and the magnitude of the surgery [14]. In other words, patients who have glucose intolerance or diabetes and experience a more invasive surgical procedure would be expected to develop more profound hyperglycemia. Hyperglycemia adversely affects morbidity and mortality in surgical and critically ill patients [3–6]. The development of these adverse effects is likely related to the numerous adverse cellular and biochemical events that occur as a result of hyperglycemia. For example, risk of infection is increased with severe hyperglycemia, because of abnormalities of monocyte and polymorphonuclear neutrophil function, decreased intracellular bactericidal activity, and glycosylation of immunoglobulins [15, 16]. Blood coagulation is activated by hyperglycemia, as circulating prothrombi Continue reading >>
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 >>
Do You Have Diabetes? 5 Tips For Successful Heart Surgery
While having diabetes puts you at a greater risk for complications during surgery, you can put a cap on these risks by being sure your diabetes is well controlled. Even small changes in blood glucose levels make a big difference. If blood sugar is not well-managed, it raises risks for wound infections, which account for about two-thirds of post-operative problems with diabetes. High blood sugar also increases the risk for stroke, cardiac arrest, lower limb ischaemia (a sharp decrease in blood flow to the legs and feet) and pressure sores — and may also result in a longer stay in intensive care. If you need surgery right away, you may not have time to get your blood glucose under control beforehand. But if there is time, here are five things you can do to improve your numbers: 1. Stay on top of blood sugar levels. It’s important to consistently and carefully measure your insulin levels to keep them under control. 2.Take all your medications. Be sure to follow your doctor’s advice about taking oral medications as well as injections. 3.Watch your waistline. You want to eat right and exercise consistently. 4. Consider seeing a diabetes specialist. Your doctor might recommend working with a diabetes specialist to help you get on track. 5. Don’t ignore other health conditions. If you have another condition besides diabetes, such as high blood pressure, high cholesterol or kidney disease, get those under control as much as possible. Each condition increases your risk for a poor outcome. No matter what, be sure to talk with your doctor ahead of time about which surgical procedure is safest and best for you. You might explore minimally invasive surgery or bypass grafting, which often can provide better outcomes for patients with diabetes. What to focus on after heart sur Continue reading >>
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 >>
Precautions For Patients With Diabetes Undergoing Surgery
Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. There is a rising incidence and prevalence of diabetes mellitus. About 50% of people with diabetes mellitus are unaware of their condition. Approximately 25% of all patients with diabetes undergoing surgery are undiagnosed on admission to hospital. Patients with diabetes have a higher risk of cardiovascular disease. Patients with diabetes have a higher perioperative risk. They are more likely because of their disease to require surgery and those undergoing surgery are likely to be less well controlled and to have complications from their diabetes. Surgeons and anaesthetists operating on patients with diabetes should be familiar with the risks attached to having diabetes, and to the particular risks of the particular surgery and of anaesthesia in patients with diabetes. Risks and complications of diabetes mellitus Patients with diabetes mellitus are at risk of the complications of the disease. It is worth considering these in outline when considering how best to care for patients with diabetes undergoing surgery. See also separate Diabetes Mellitus article. Perioperative risks and complications of diabetes mellitus It is important in assessing risk of complications in patients with diabetes undergoing surgery to consider the specific type of surgery and anaesthetic technique. There is evidence for higher risk in those with diabetes undergoing surgery and, when such evidence is lacking, it may in part be testament to the relative safety of modern surgery and anaesthesia. However, the following risks and observati Continue reading >>
Diabetes And Spine Surgery: What You Need To Know
If you have diabetes and will undergo spine surgery, you need to make special accommodations to ensure a successful surgery and recovery. People with diabetes are at a higher risk for certain issues, such as infection and slower healing. Fortunately, you can take steps before and after spine surgery to reduce the potential for these complications. Diabetes and Spine Surgery: Why an Increased Risk of Complications? Neck or back surgery can cause physical and mental stress that leads to changes in your body’s hormone levels. These changes can cause increased insulin resistance, a condition in which the body produces insulin—a hormone that regulates the amount of sugar (glucose) in the blood—but does not use it effectively. Hormone fluctuations can also cause the body to produce less insulin and lead to other changes that increase the risk of hyperglycemia, or high blood sugar. High (or low) blood sugar levels increase the risk and severity of complications after surgery. If you have diabetes, the risk of complications after surgery is greater if you have had diabetes for a long time, frequently have high blood sugar levels, or if you have trouble controlling your levels. That’s why it’s important to work with your diabetes care team to develop strategies to manage your blood sugar before you undergo spine surgery. Medication Considerations for People with Diabetes Talk with your healthcare provider about what steps you should take to control your diabetes before spine surgery. In some cases, this will involve changes to your diabetes medication. Be sure that these steps are communicated to the surgeon. It may be helpful to see a certified diabetes educator (CDE). Medicare covers two hours of diabetes self-management education (DSME) per year, with your healthcar Continue reading >>
High Blood Sugar May Raise Risk For Surgical Wound Problems: Study
Important for diabetics to get glucose levels under control before procedures, authors say Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And "More information" links may no longer work. Questions about personal health should always be referred to a physician or other health care professional. FRIDAY, Oct. 4, 2013 (HealthDay News) -- Diabetes patients with high blood sugar levels are at increased risk for surgical wound-related complications after having surgery to close chronic skin ulcers caused by diabetes, a small new study says. The findings show the need for better blood sugar control in these patients before they have such surgery, the researchers noted. Their study of 79 patients found that the risk of serious wound complications was more than three times higher among those with high blood sugar before and after surgery, and in those with poor long-term diabetes control. The complications included wound dehiscence (re-opening of the surgical incision), wound infections and repeat surgery. Among the specific findings, wound dehiscence occurred in 44 percent of patients with high blood sugar levels before surgery, compared to 19 percent of those with good blood sugar control. The risk of wound dehiscence was also higher among patients with high blood sugar levels after surgery and among those with poor long-term diabetes control, according to the study in the October issue of the journal Plastic and Reconstructive Surgery. Patients with wide swings in blood sugar levels were four times more likely to require repeat surgery, according to a journal news release. Although the study found an association between higher blood sugar levels and wound problems, it did Continue reading >>
How To Manage Diabetes While On Oxycodone
What happens to a person’s blood sugar when they are under stress due to pain, and must take a narcotic pain reliever such as oxycodone? In this article, we will explore what happens to a person with diabetes who is taking long term pain medication. We will look at whether it raises or lowers blood glucose. We will look at how taking oxycodone affects blood glucose levels, activity levels and appetite, and how that could influence the self-management of diabetes. We will look at ways that you can maintain blood glucose in target ranges while taking a narcotic pain reliever such as oxycodone. John’s story As John relayed to me during a phone conversation, he is taking a combination of oxycodone plus acetaminophen for severe pain in his legs related to poor circulation and neuropathy because of his Type 1 diabetes. He has had severe sleep disruption, and was getting no relief on nonsteroidal anti-inflammatory agents. He has been taking oxycodone now for about three months, and has seen a need to increase the basal rate on his insulin pump in order to stay in target range with his blood glucose. He found that once the stress of the pain was gone, his numbers have stayed in range. I suggest reading the following: What is oxycodone? Oxycodone is a narcotic pain reliever that is used to relieve moderate to severe pain. It is in the class of drugs called “opiate analgesics,” and can be found in combination with other nonsteroidal anti-inflammatory medications such as aspirin, acetaminophen, or ibuprofen. Oxycodone can also be found in combination with aspirin and acetaminophen. Each of these components can also have side effects in addition to the oxycodone. Brand names of combination medications include Nortab, Vicodin, and Lortab and Percocet. Precautions for oxycodo Continue reading >>
High Blood Sugar Increases Risk Of Blood Clots After Surgery
Study finds a sixfold higher threat of pulmonary embolism after hip or knee replacements Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And "More information" links may no longer work. Questions about personal health should always be referred to a physician or other health care professional. HealthDay Reporter MONDAY, Oct. 16, 2006 (HealthDay News) -- Patients, such as diabetics, who have high blood-sugar levels before undergoing hip- or knee-replacement surgery are at increased risk of developing potentially life-threatening blood clots, according to a new study. "The take-home message is that all patients should get their blood sugar under control before undergoing elective surgery," said the study's lead author, Dr. Boris Mraovic, an assistant professor of anesthesiology at Thomas Jefferson University in Philadelphia. Mraovic's team examined records of 6,500 patients who underwent hip- or knee-replacement surgery at Thomas Jefferson University Hospital between 2003 and 2005. They identified 38 patients who had blood-glucose levels above 250 milligrams per deciliter during pre-operative testing and on the day of surgery. All but one of the patients were diabetic, which is defined as a fasting blood-glucose level above 126 mg/dl. "We found that 10.5 percent of those with high blood sugar developed a pulmonary embolism compared to only 1.7 percent of the other patients," Mraovic said. "This rate is more than six times higher than we would expect to see in the general population." Pulmonary embolism is a potentially life-threatening condition in which a blood clot forms in a vein and travels to the lungs. It's usually caused by clots that form in veins deep in the m Continue reading >>
What Causes High Blood Pressure After Surgery?
All surgeries have the potential for certain risks, even if they’re routine procedures. One of these risks is the alteration of blood pressure. People can experience high blood pressure after surgery for a number of reasons. Whether or not you develop this complication depends on the type of surgery you’re having, the type of anesthesia and medications administered, and whether or not you had issues with blood pressure before. History Heart surgeries are often associated with a risk for blood pressure spikes. One reason for this might be that many people having these surgeries already have high blood pressure. If your blood pressure is poorly controlled before going into surgery, there is a good chance you’ll experience complications during or after surgery. Blood pressure is measured by recording two numbers. The top number is systolic pressure, which describes the pressure when your heart is beating and pumping blood. The bottom number is diastolic pressure, which describes the pressure when your heart is resting between beats. You’ll see the numbers displayed as 120/80 mmHg, for example. According to the National Heart, Lung, and Blood Institute, these are the ranges for normal, borderline, and high blood pressure: Normal: less than 120 over less than 80 Borderline: 120 to 139 over 80 to 89 High: 140 or higher over 90 or higher Having poorly controlled high blood pressure means that your numbers are in the high range and you’re not being effectively treated. This could be because doctors haven’t diagnosed you before surgery, your current treatment plan isn’t working, or maybe you haven’t been taking medication regularly. Medication Withdrawal If your body was used to blood pressure-lowering medications, it’s possible that you may experience withdraw Continue reading >>
Pharmacist-led Program Helps Manage Blood Sugar After Surgery
With commentary by study co-author Karen Mularski, MD, a hospitalist at Kaiser Permanente Northwest, Portland. When patients with diabetes undergo surgery, keeping an eye on their blood sugar during and after the procedure is crucial to keep them healthy, experts know. Better blood sugar control is linked with better results from the surgery, lower readmission rates to the hospital and fewer complications. Now, Oregon researchers report that implementing a blood glucose control program with a team led by specially-trained pharmacists produces good results. "What we found was, the blood sugar was much better controlled after implementation of the team," says Karen Mularski, MD, a study co-author and hospitalist at Kaiser Permanente Northwest, Portland. While awareness of the need to monitor blood sugar in surgical patients is high, she says, it isn't always paid the attention it needs. "Doctors have so much to deal with, blood sugars can fall to the bottom of the list," she says. In the new program, keeping track of patient blood sugars was the only task for the pharmacists involved in the program. The pharmacists followed a strict protocol about blood sugar control. They determined the dose and regimen of insulin needed. If they had questions, they consulted with doctors overseeing the program, Dr. Mularski says. The study is published in September/October 2015 print editition of The American Journal of Pharmacy Benefits. The patients in the study were not critically ill. Their surgeries included such procedures as thyroid operations, appendectomies, hip replacement and hysterectomies. The researchers compared the outcomes of about 4,800 patients during the first year of their two-year study and another 5,400 during the second year to about 1,200 patients hospitalized i Continue reading >>
