By: J. Todd Walker, MD
PWD, Type 1 Turned Orthopaedic Surgeon
It’s a good idea for anyone having surgery to be as prepared as possible, but it’s especially true for people with diabetes.
As a type 1 diabetic and orthopaedic surgeon, I know firsthand the challenges both patients and surgeons face. People with diabetes have an increased risk for certain complications such as infections, cardiac issues, kidney compromise and poor wound healing. With these additional challenges, what can a person with diabetes do to boost their chances for a successful surgery?
1. Get your diabetes under control and discuss potential risks with your doctor
Ask your doctor which specific risks are increased for your surgery and what steps you can take to mitigate them. His or her answers will depend on the type of surgery, how long it will last and the typical issues for that particular type of surgery.
As I mentioned earlier, one of the most common risks for people with diabetes is the possibility for infection. It’s very important for doctors to counsel all patients on this issue because infections happen all too frequently. As a precaution, antibiotics are given both pre and postoperatively in an attempt to prevent them.
Having a healthy immune system with adequate blood sugar control over the past several months is another way to decrease wound healing issues and complications after surgery. Keeping your blood sugars at minimum below 200mg/dl most of the time several weeks in advance of surgery is one of the best things you can do to aid in the postoperative healing process.
2. Communicate with everyone on your medical team
Your primary care doctor, endocrinologist, surgeon and especially your anesthesiologist should all be involved with planning your surgery.
People with diabetes need to have a preoperative evaluation before an elective surgery, and a recent A1c checked within the past 3 months. Depending on the type of surgery, some doctors might consider delaying surgery if your A1c is too high. A cardiologist visit could be included if you are at risk or have heart disease.
If you are planning to stay in the hospital for few days, make sure you coordinate meal planning with the hospital ahead of time (find out if you can order in! J).
Meals with the right nutritional balance can help with postoperative glycemic control and decrease the risk for infections. Keeping your glucose levels below 200mg/dl while in the hospital is also important.
If needed, make sure you have support people in place for any post surgery assistance that might be required.
Important questions to ask your surgeon:
- When should I have my last meal/fluids?
- When should I take my last dose of insulin and/or medications? Or do I need to reduce my dose of medication or stop it all together?
- What do I do if I have low or high blood glucose the morning of surgery?
- Who will manage my diabetes during the surgery?
- What is my post-surgery therapy plan?
- If you are on an insulin pump and/or CGM, make sure you will be able to continue to wear them while in the hospital (especially your CGM – and teach your anesthesiologist to use it!)
3. Know that your doctor will treat your surgery differently
Your surgeon should know that diabetes can affect your operation. It is your responsibility to discuss this topic with him or her. Your doctor knows the potential outcomes that are associated with diabetes and/or high blood sugar and, like you, wants the best possible outcome for you.
The good news is that a surgeon’s knowledge of diabetes can help decrease adverse outcomes. Your doctor might recommend holding off on some of your medications prior to and after surgery. Please discuss medication changes with all physicians taking care of you. Ask your doctor what kind of medications (other than your normal ones) you will be taking while in the hospital and after discharge. Many doctors will stop oral medications and place you on subcutaneous or IV insulin. Surgery and anesthesia can place stress on your body with resultant hyperglycemia, leading some surgeons to admit people with diabetes on the day prior to admission for optimization of diabetes control.
(Insider Hint: To decrease the length of time fasting before your surgery and to prevent hypoglycemic episodes, ask your doctor if you can be first on the schedule for the day.)
It’s also a great idea to bring your glucose meter to the hospital so you can help your nurses and doctors keep your diabetes in range postoperatively.
4. Discuss Post-Surgery Plans
Your doctor is already planning your post-surgical therapy, and expect that it might take a little extra time to heal. For example, after an ankle surgery, it is recommended that people with diabetes do not bear weight on their leg for 8-12 weeks, twice as long as the population without diabetes. Ask your doctor how diabetes will affect your rehabilitation after surgery.
5. When to Call Your Doctor
Keep an eye out for signs of infection and call your doctor if you notice any of the following:
- High fever
- The incision site feels hot or is excessively red, swollen, more painful or oozing any smelly fluid.
The good news!
Adequate blood sugar control has been shown to have shorter lengths of hospital stays, a decreased rate of infections and decreased costs. With a multidisciplinary approach and communication between all team members and the patient, the outlook for a successful surgery is brighter than ever.