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Surgery And Diabetes

More than two-thirds of all Americans are overweight or obese. And with obesity comes a host of co-morbid conditions, including Type 2 diabetes. Endocrinologists and bariatric surgeons at UPMC are finding that bariatric surgery now offers obese patients with Type 2 diabetes the possibility that their condition will diminish or in some cases, even disappear.

According to statistics, every second person suffering from diabetes is subjected to surgery in a given period of time. Peculiarities of the disease, such that the resulting damage to tissue during surgery, the risk of infection that is  greater for about 5-6 times than that in people with normal metabolic processes in the body. At the same time, we should not forget that poor healing of after-surgery-scars is observed in one third of cases.

Surgery And Diabetes

Features of surgery for diabetic patients

Any surgery applied to diabetic body has a negative impact on blood sugar levels, because at that time a person experiences stress, the usual schedule of eating and drinking is disrupted and the lack of exercise occurs. In addition, anesthesia also has an additional negative effect on the heart and blood vessels, so people suffering from diabetes before and after the operation should be under the strict supervision of specialists .

Elective surgery

The main purpose of the physician in the planned operaion of a diabetic person is a constant monitoring of blood sugar levels, before surgery, during anesthesia and during the post operative perioв. To prepare for еру planned surgery, the patient should:

  • Visit the doctor a month before the surgery to undergo glycemia stabilization.
  • Check for complications of the cardiovascular system .
  • Report their illness to anesthetist and surgeon and discuss the treatment plan.
  • Use a glucometer to check blood sugar levels four times a day .
  • Surgery should be preferrably assigned in the early morning .

Surgery undertanken under local anesthesia

Without a doubt, the vast majority of surgeons recommend to spend handling diabetic patients under local anesthesia. If there is no need to stop eating before surgery, there is no need to change the diabetic diet. Monitoring blood glucose is much easier when the person is conscious. Depending on the indication of the glycemia, you can change the dose of insulin directly during surgery.

Urge handling diabetics

The nature of the treatment during urge operatons will entirely depend on the time when the last injection of insulin was made, when the person ate food for the last time or it will depend directly on the blood sugar level at the time of surgery.

As a rule, in case of emergency operating, the blood sugar level almost never gets back to the normal range. Engaging in its recovery before surgery does not make sense, because it is expedient to do so in the post operative period.

After urgent surgery, the treatment of patients with diabetes is similar to the one that was conducted before the sugrery

Important aspects of the surgery

The vast majority of anesthetic drugs enhance the level of sugar in the blood. It should be remembered that the intravenous drugs are safer . Among exceptions is Ketamine, as it causes hyperglycemia.

In case of diabetic autonomic neuropathy of the patient, difficulties may arise during operation. First, the stomach is full even when fasting. Therefore, it is necessary to implement timely prevention of regurgitation.

With the defeat of the sympathetic nerves in response to cardiac output, there may decrease the degree of narrowing of blood vessels at the beginning of the anesthetic effect. Such a condition may be exacerbated by hyperventilation or bleeding.

During orthostatic hypotension or arrhythmias there is a risk of complications after anesthesia. Such were patients previously prescribed low-dose heparin and administration of antibacterial agents. It should be remembered that the indiscriminate introduction of antibiotics among patients with diabetes may lead to the development of resistance to these drugs .

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