Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Uncontrolled diabetes can bring about surgical complications.
Sommer said, “Uncontrolled diabetes means blood glucose levels are consistently higher than recommended. Over time, this can affect blood vessels, nerves and the immune system, all which are critical for healing after surgery. There are several risk factors, risk of surgical site infections, delayed wound healing, wound breakdown or poor closure. It makes the wound harder to close because the tissue is not as healthy. Increased risk of hospitalization or readmission if the surgery was originally performed in the hospital setting, and in severe cases, it’s sepsis, which is a blood infection. So high blood sugar creates an environment where bacteria can thrive and the immune system struggles to respond.”
What is actually happening in the body?
Sommer said, “The blood becomes more viscous or thick, reducing oxygen delivery to the tissues. So if you think of sugar, something that’s really sugary, as it melts, it gets very sticky. That’s what’s happening in your body when your blood sugar is really high, making the heart work harder to pump the thick blood to get to all your vital organs and your tissues. Hence that’s where you get the delayed surgical healing from. White blood cells don’t function properly. They’re weakened by the infection, weakening the infection defense. There’s increased inflammation, meaning that healing will be slower in the presence of an increase of inflammation. Collagen production is impaired, and that is what affects the wound closure. So the body cannot heal the way it should if the glucose in your blood, your blood sugar is high.”
What procedures are followed for surgery?
Sommer said, “Normal fasting blood glucose levels are 80 to 130. For diabetics, they want your blood sugar in that range, a random blood glucose, meaning less than 180, so if you ate and we checked your blood sugar an hour or two after, we would like to see it less than 180. Hemoglobin A1C, that is something that is measured. It means that that value is the course of the three month period, because it’s the life of a red blood cell, how your sugar has been over three months. So the goal, ideally, it’s below 7% for surgical procedures and a lot of Type 2 diabetics that have had struggles controlling their diabetes, as long as their number is under eight, they usually are okay for surgery. If your hemoglobin A1C is above 8% or 9%, the surgery is often delayed, especially if it’s an elective surgery, because you don’t want to go in and fix something that could wait, and you do it too soon, and your blood sugar is too high, and then you don’t heal properly, and it just adds to a longer recovery period and complications. If you have a fasting blood sugar that’s over 200 or even if you ate two hours later and it’s over 200 they’re not really going to jump in and do your surgery, especially if it’s an elective emergency surgery, but when you’re talking about like hernia repair or gallbladder, as long as the symptoms are controlled and there isn’t an emergency they’re not going to jump in and do your surgery right right away until your blood sugar is controlled.”
Blood sugars will need to be checked during and after surgery.
Sommer said, “Patients will typically, if they’re diabetics, they do normally check their blood sugar once a day. They might recommend checking it more than once, depending on what your history is and what medications you’re on. If you’re in the hospital, they maintain levels, and you need to be admitted, they will maintain a level between 140 and 180. Both high and low blood sugar can be dangerous, so you need to monitor it, especially if you’re having a surgical procedure. And I just want to mention, when you have surgery, it creates stress, even though it’s a controlled environment. So that’s why it’s also important to monitor your blood sugar and know what it is before and after surgery.”
Medication can help.
Sommer said, “GLP1, and you may need to stop or be held before surgery. Remember, it’s either one to two weeks. It could even be longer depending on the type of surgery that you’re having. Insulin is usually adjusted. So a lot of times, patients who are on long acting insulin for Type 2 diabetes, Type 1 diabetic, or on short acting insulin, or they’re on an insulin pump. Medications like metformin and other types of oral medications may be held the day of surgery, just so your blood sugar doesn’t drop because you haven’t eaten, and you were fasting from midnight the night before. Patients should always follow instructions from their surgeon, primary care provider, or an anesthesia team. Usually they’re all involved. When you go to have surgery, your primary care provider needs to give you the green light that yes, the surgeon can do the surgery, and then the anesthesiologist reviews everything to make sure that you’re fit for anesthesia.”
What patients are at higher risk?
Sommer said, “Those with long standing diabetes. Those would be your Type 2 diabetics that were diagnosed early on in their adult life, poorly controlled blood sugar, and that means your hemoglobin A1C is above eight or nine, if you’re obese, if you have kidney or vascular disease, and of course, smokers who are more at risk for everything. Because Type 2 diabetes occurs silently, sometimes people don’t even know they have it. It kind of sneaks up on you. So patients come to us with hernias or symptoms of gallbladder, and they’ve never seen a primary care doctor so we can get their pre op blood work. It’s balancing. A low sugar diet, staying hydrated, avoid smoking and alcohol, especially if you’re a diabetic, because alcohol can mess with your blood sugar. Check your blood glucose regularly. Like I said, most diabetics, Type 2 diabetics, will do it once a day, or Type 1, they check it daily for sure, and maybe even multiple times a day. They have continuous blood glucose monitors. Work with your provider, make sure your medications are optimized, and maybe you have a hemoglobin A1C fairly recent prior to your surgery. Anything you can do weeks before to get your sugar under control, or just maintain it will give you a better outcome when you have your surgery. If your blood sugar is controlled, you’ll heal faster, you’ll reduce complications, and you’ll just improve overall outcomes. It’s about safety and recovery.”
For more information, click here: https://www.keywestsurgicalgroup.com/v