Surgery without complications in diabetic patients is not a myth. Good blood sugar control before and after surgery has a positive effect on recovery.
In general, there are 2 types of operations:
Minor surgery : Typically, local anesthesia is used for this type of surgery and the patient recovers quickly after surgery. Usually the patient is not hospitalized – he is discharged on the same day.
Major surgery : Usually performed under general anesthesia and therefore requires hospitalization of the patient. Accordingly, recovery takes longer.
Regardless of the nature of the operation, it is necessary to prepare for it and, together with a team of medical professionals involved in the treatment of diabetes, plan the actions for the periods before, during and after the operation. Having a clear plan will help reduce the stress associated with surgery.
As a rule, it is recommended to increase blood sugar targets slightly to avoid hypoglycemia. Usually, 5.5-10 mmol/L is considered a good target range, but this range should be approved by the physician based on the specific situation.
With proper planning, the patient should know whether to change basal insulin doses on the day of surgery. These changes include adjusting the temp basal rate in your insulin pump. This planning allows the patient to prepare for compliance on the day of surgery.
It is generally recommended to lower the basal rate percentage on the day of surgery.
Long-acting insulins are often difficult to control during minor surgery. An insulin pump with ultrashort insulin can help adapt the mechanism of insulin action to the duration of the operation.
The patient should also discuss with their diabetologist what to do if their blood sugar levels are outside the target range on the day of surgery. The presence of this plan directly affects the degree of confidence of the patient in the event of an unpleasant situation and allows you to guarantee the safety of the entire process.
An insulin pump with a continuous glucose monitoring (CGM) system can be an excellent assistant during minor surgical interventions. If the physician and patient decide to use such an LMWH pump (and the surgery allows it), it will help to ensure very good blood sugar control throughout the operation. Continuous glucose monitoring technology allows you to fully control your blood sugar levels. Trend arrows are especially useful for predicting and problem solving.
The following questions should also be discussed with the Chief Surgeon and Anesthetist before surgery. It is very important that they are aware of the presence of diabetes in the patient; even if they are not diabetes specialists, they can help based on the patient’s blood glucose data (especially when it comes to major surgery).
Questions to ask during the planning phase:
- Who will be responsible for diabetes management during my stay in the hospital? Who should be notified if my blood sugar is out of my target range on the day of my surgery, or if I have eaten a food that could affect my blood glucose?
Major surgery may require hospitalization for several days. In this regard, it is necessary to understand how insulin will be administered not only in the operating room, but also in the ward after the operation.
- Will I be able to use my insulin pump and CGM during my surgery?
Be aware that radiation equipment is used in some surgical procedures, so it may not be safe to use an insulin pump or sensor in the operating room. If the sensor is not secured in the area where the operation is being performed, and there is no risk of damage, the use of a continuous glucose monitoring sensor is not actually prohibited.
- Who will be responsible for diabetes management during the operation?
During the operation, the anesthesiologist or surgeon may administer insulin or glucose (depending on the need) to keep the blood sugar level in the required range.
It is possible that doctors will decide to turn off the infusion system and use conventional therapy with injections. It is very important that the patient is aware of this and is involved in decision making and in the process of switching back to an insulin pump.
Intensive glycemic control has a beneficial effect on recovery after surgery, regardless of the presence of complications.
In general, the best recommendation in these cases is to work together and plan for all situations that may arise.