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What To Do When Blood Sugar Is High Before Surgery

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 >>

High Blood Sugar May Raise Risk For Surgical Wound Problems: Study

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 >>

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 >>

Should My Blood Sugar Be Under 200 Before Surgery?

Should My Blood Sugar Be Under 200 Before Surgery?

Blood sugar is one of those things that we like to make as good as we can prior to any elective surgery. Diabetics with significantly elevated blood sugars have a more difficult time healing and have a greater potential for infection. Ideally, the blood sugar should be at its best controlled level for about a month prior to cataract surgery. I have seen cataract surgery performed with a blood sugar as high as 200 when we knew that the primary care doctor just can't get it to go any lower. But this is not an optimal situation. Continue reading >>

Peri-operative Management Of The Surgical Patient With Diabetes 2015

Peri-operative Management Of The Surgical Patient With Diabetes 2015

Summary Diabetes affects 10–15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre-operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol−1); deciding if the patient can be managed by simple manipulation of pre-existing treatment during a short starvation period (maximum of one missed meal) rather than use of a variable-rate intravenous insulin infusion; and safe use of the latter when it is the only option, for example in emergency patients, patients expected not to return to a normal diet immediately postoperatively, and patients with poorly controlled diabetes. In addition, it is imperative that communication amongst healthcare professionals and between them and the patient is accurate and well informed at all times. Most patients with diabetes have many years of experience of managing their own care. The purpose of this guideline is to provide detailed guidance on the peri-operative management of the surgical patient with diabetes that is specific to anaesthetists and to ensure that all current national guidance is concordant. What other guideline statements are available on this topic? The NHS Diabetes Guideline for the Peri-operative Management of the Adult Patient with Diabetes [1] was published in 2011 by NHS Diabetes (now part of NHS Improving Quality), and is due to be updated in 2015. Why was this guideline developed? This guideline was developed to improve both the safety and the outcome of patients with diabetes undergoing surgical procedures. How and why does this statement differ from existing guidelines? The 2011 guideline [1] deals wi Continue reading >>

Medicine Management Before Surgery

Medicine Management Before Surgery

AMBULATORY CARE: Medicine management before surgery means creating a plan with your healthcare providers to stop, start, or change your medicines. The plan can help prevent complications during and after surgery. The plan may also prevent your surgery from getting canceled or delayed. How to create a medicine management plan: Tell all of your healthcare providers about your surgery. Schedule appointments to see them before your surgery. You may need blood work or tests before surgery to help your healthcare provider make changes to your medicines. Some of your medicines may need to be stopped several days to weeks before surgery. Other medicines may be stopped the night before, or need to be taken the day of surgery. Do not stop taking your medicine until you talk to your healthcare providers. Bring a list of all of your medicines, vitamins, and dietary supplements to your preoperative appointment and on the day of surgery. You may also bring your pill bottles. This will help your anesthesiologist plan your anesthesia and keep you safe during and after surgery. If your healthcare provider tells you to take medicine on the day of surgery, take it in the morning with a sip of water. On the day of your surgery, tell healthcare providers what medicines you did or did not take that day. Contact your healthcare provider if: You have questions about when to stop taking your medicine before surgery. You have questions about what medicines to take or not take on the day of your surgery. You need a prescription refilled before surgery. Blood thinner and antiplatelet medicine: If you take blood thinners or antiplatelet medicines, you may be at risk for heavy bleeding during or after surgery. Ask your healthcare provider if you need to stop taking your medicine, and when to stop. A Continue reading >>

Champions For Excellent Care - We Are An Aaha-accredited. That Means We Hold Ourselves To A Higher Standard.

Champions For Excellent Care - We Are An Aaha-accredited. That Means We Hold Ourselves To A Higher Standard.

Surgery FAQs What You Need to Know Before Your Pet's Upcoming Surgery Many people have questions about various aspects of their pet's surgery and we hope this information will help with the decisions you will need to make before your pet's upcoming surgery. Our surgery check in forms are available at the bottom of the page. We need you to drop your pet off for surgery in the morning, between 8 and 8:45 am. You may pick your pet up from out patient surgery after 4 pm. Is the anesthetic safe? Today's modern anesthetic monitors have made surgery much safer than in the past. Here at the Pet Hospital of Penasquitos, we do a thorough physical exam on your pet before administering anesthetics to ensure that a fever or other undetected illness won't be a problem. We also adjust the amount and type of anesthetic used depending on the health of your pet. We offer in-house blood testing before surgery. Our doctors prefer a comprehensive screening because it gives them the most information to ensure the safety of your pet. For geriatric or ill pets, additional blood tests, electrocardiograms, or x-rays may be required before surgery as well. Every pet needs blood testing before surgery to screen for anemia, platelet deficiencies, low blood glucose or protein, electrolyte imbalances, liver or kidney dysfunction, or any other disease that may not be apparent from history and physical examination. Even apparently healthy animals can have problems that cannot be detected without blood testing. If there is a problem, it is much better to find it before it causes anesthetic or surgical complications. If serious problems are detected, surgery can be postponed until the problem is corrected. All animals will handle the anesthetic better if they receive intravenous fluids during surgery. Ou Continue reading >>

Pre-surgery Instructions

Pre-surgery Instructions

Talk with your doctor about any medications you are taking. Some medications may need to be stopped before surgery. Unless told otherwise, do not eat or drink anything after midnight before your surgery. This includes food, water, gum and hard candy. Do not drink alcoholic beverages 24 hours before surgery. If you smoke, quit or cut down. Do not smoke or chew tobacco the morning of surgery. Bathe or shower the night before and the morning of surgery. Do not remove hair or shave near or over the surgery area. Do not apply lotions, perfumes or powders. Do not wear nail polish or make up the day of surgery. (Ask your doctor about removing artificial nails as some surgeries require this.) Brush your teeth the day of surgery. If you have dentures, do not use denture paste as they may need to be removed. Wear clean, comfortable clothes that will fit loosely over your surgery area. Remove all jewelry, including body-piercing jewelry, before coming to the hospital. Bring any crutches, walkers, canes etc. that will be needed after discharge. If you need assistance obtaining these items, please call Sauk Prairie Healthcare at 608-643-3311 and ask for Care Management. Bring a case for dentures, eyeglasses, contacts or hearing aids. If you are staying overnight, bring your personal grooming products, such as toothbrush and paste, hair care products and/or razor. If you use a CPAP machine and will be staying overnight, please bring the machine and all accessories with you. Children may bring their favorite blanket, teddy bear, drinking cup or bottle. Do not bring any valuables with you, as Sauk Prairie Healthcare will not be responsible for the loss, theft or damage of any valuables, including jewelry. Your surgeon will speak to family members/ caregivers (or whomever you choose) af 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 >>

Post Surgery Blood Sugar: High But Not Worried

Post Surgery Blood Sugar: High But Not Worried

“If you have all that inflammation, your blood sugar will be high. And if you still have pain then you probably still have inflammation,” Jessica told me after I told her that my morning blood sugar was 225. This morning wasn’t exceptional in any way. My blood sugar has been out of control since my surgery last Wednesday. Most mornings begin somewhere between 200-250 and the rest of the day is spent chasing my blood sugar down, but it seems as if the glucose meter is broken and won’t go south of 150. I expected this to happen, but thought I would be able to control it better and that it wouldn’t last this long. I’ve tried different things. On Thursday afternoon I gave in and took Tylenol for the pain. The Tylenol did make me feel better, but still, my blood sugar remained high despite the fact that I was feeling less pain. Friday morning I decided to set my basal rate to 150%, but that, too, had little effect on my blood sugar levels. It may have allowed me to bolus less, but my blood sugar levels stayed high. Since my surgery I have cut down even more on the carbs while using way more insulin than I usually do. Normally, I use 17-18 units of insulin a day and now have been using around 25 units. The first few days the high numbers drove me nuts. I actually told Jessica one day that I would love to have a low. You know you’ve been a diabetic for a long time when you catch yourself saying, “Something in the 40’s would be nice.” On Monday, feeling a little better physically, I went out on my first walk outdoors since my surgery (a quarter of a mile). While walking, slowly, carefully and a little hunched over I thought about my blood sugar. I wasn’t thinking about my health in that moment, but I was actually worried that these numbers would ruin my ne 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 >>

Diabetes Medications: Blood Glucose Management Before Surgery

Diabetes Medications: Blood Glucose Management Before Surgery

F A C T S H E E T F O R P A T I E N T S A N D F A M I L I E S When you have diabetes, managing your blood glucose is always important. But before you have surgery, it’s vital. This sheet tells you why— and explains what you can do to prepare. Why is my blood glucose so important right now? Studies show that people with well controlled blood glucose have fewer problems during and after surgery. But unfortunately, staying in control might not be so easy. Surgery can cause big problems in blood glucose levels — even if you normally have things under control. Here’s why: • Surgery is stressful. Stress usually increases before, during, and after surgery. Beforehand, you’re probably a bit nervous. During and after surgery, your body is stressed, trying to heal itself. And unfortunately, stress makes your body release hormones that make it even more difficult than usual to regulate blood glucose. • You may go off your normal meal plan. Often your doctor will give you special instructions about eating and drinking in the hours before surgery. And for a few days after, you might not eat normally either. Going off your meal plan can cause changes in blood glucose levels. • Depending on what type you take, you may be told to stop taking your diabetes medications before surgery. Or you may need to switch to a different medication, or adjust your dose. The stress and changes that surgery brings can push your blood glucose too high — or too low. Very high or low blood glucose can be dangerous at any time. But they’re especially risky when they happen during or after surgery. They can cause dangerous complications and slow your recovery. So to avoid problems, feel better, and get well faster — control your blood Continue reading >>

What You Need To Know About Surgery And Diabetes

What You Need To Know About Surgery And Diabetes

Surgery is sometimes unavoidable, and if you're one of the nearly 30 million Americans suffering from diabetes, getting your body ready for surgery is critical to ensuring a healthy recovery. Taking care of your body in the weeks and months leading up to your surgery can have a huge impact on how well your body is able to recover. How does Diabetes Affect My Body's Recovery from Surgery? Poor Circulation People who suffer from diabetes have difficultly processing sugar which leads to elevated blood sugar levels. As a result of elevated blood glucose levels, arteries tighten up, becoming more narrow and less blood is able to circulate through your blood vessels. Decreased blood flow also means less oxygen reaching your wound. Immune System Deficiency Elevated blood sugar levels reduce the ability of red blood cells to bring nutrients to the tissue which results in healing taking considerably longer. This makes things even worse, because your wounds are slower to heal there is increased risk of infection, and when infection does occur less white blood cells are available to fight off the infection due to the reduced blood flow. Diabetic Neuropathy Diabetic neuropathy is a nerve disorder caused by diabetes. It causes a loss of sensation in nerve endings, making it less likely for patients recovering from surgery to be able feel a developing infection or other surgical issue. Delayed detection of these issues means they may become more severe before action is taken. Domino Effect While diabetes itself is dangerous enough, it's the cascading complications that can occur as a result of diabetes that pose the true danger. In addition to wounds taking longer to heal, infections being more likely to occur, and those resulting infections taking longer to overcome, people who suff Continue reading >>

Diabetes And Spine Surgery: What You Need To Know

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 >>

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 >>

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