Over 18 million Americans have diabetes and many will require surgery at some time in their lives. For the person with diabetes surgery presents several challenges. Before and after surgery the individual may require adjustments in the diabetes
regimen to maintain acceptable blood glucose levels.
Having diabetes can increase your risk for having a complication after surgery. Such as:
- Slow healing
- Heart Problems
The risk for these problems can be greatly reduced with blood sugar monitoring and control prior to surgery.
Pre-surgical lab work:
All pre-surgical patients will have lab work drawn before their surgery. An A1c test will be included in this lab work for:
- All pre-surgical patients with diabetes
- All pre-surgical patients meeting diabetes screening criteria for adults without symptoms
- All patients with fasting glucose of 126 mg/dl or above or non-fasting blood glucose of 200 mg/dl or above.
What should my blood glucose levels be prior to surgery?
- Before meals: 80-130 mg/dl
- 1-2 hours after meals: below 180 mg/dl
(based on American Diabetes Association recommendations)
In preparation for surgery there are several things you need to do to manage your diabetes.
- Monitor your blood glucose 2-4 times daily.
- Inform the physician who manages your diabetes of your upcoming surgery and obtain instructions regarding your diabetes medications.
- Develop a plan with your physician on how to handle your diabetes medications the day of your surgery.
- If you are on insulin, the dose may need to be decreased the day before surgery to prevent low blood sugars. Contact your doctor for instructions.
Instructions for Hypoglycemia (Low Blood Glucose/Sugar) Treatment before surgery
Suggestion for prevention:
Eat a protein snack at 10:30 p.m. the night before your surgery
Examples: Peanut butter, Cheese and whole wheat crackers, Almonds and dried fruit
Symptoms of Hypoglycemia (low blood glucose/sugar):
- Nervousness, shakiness, and weakness
- Extreme hunger and slight nausea
- Dizziness and headache
- Blurred vision
- A fast heartbeat and feeling anxious
If you are having symptoms of low blood sugar, always do a fingerstick blood sugar to see what your blood sugar is. You should not treat based on just how you feel.
Treat hypoglycemia ONLY if you have symptoms of hypoglycemia and your blood sugar is less than 110 mg/dL after midnight:
- Drink 6 oz. of clear liquids containing sugar: Gatorade (No red) or Sprite
- Recheck blood sugar in one hour
If lower than 110 mg/dL, repeat liquids
If your blood sugar continues to be lower than 110 mg/dl and you are still symptomatic, repeat steps for up to two hours. After two hours, if your blood sugar remains low, plan to arrive to hospital at 5:30am for anesthesia and preoperative treatment of blood sugar.
Surgery and anesthesia cause the release of stress hormones. These hormones make the body less sensitive to insulin which may result in elevated blood sugars.
- All patients with type 1 diabetes require insulin during surgery.
- Many patients with type 2 diabetes will require insulin during surgery even if they are managed with diet, exercise and oral medication before surgery.
Management of diabetes after surgery should include:
- Frequent blood glucose monitoring.
- Talking to your doctor.
Based on the type of surgery, the individual may not be able to eat or drink for a period of time. Adjustment to the dose and/or frequency of diabetes medication may be needed.
If you have to stay overnight in the hospital:
- Your blood sugar will be checked 5 times daily
- You will be given a diabetic diet while in the hospital to help control your blood sugars
- You may be given insulin if your blood sugar is greater than 180 mg/dl (even if you are not on insulin at home)
When you are at home:
- You should do your best to keep your blood sugar 80-130 in order to decrease your risk of postoperative infection and promote healing
- Check your blood sugar 2-4 times per day for 4 weeks after surgery.
- If your blood sugar is greater than 200 mg/dl you should notify your doctor. You may need your medication adjusted.
- Make sure to stay hydrated with water, sugar-free drinks, popsicles, gelatin
- Never skip your insulin or oral medication unless approved by your doctor.