Once diagnosed, a person with diabetes has a full time commitment to properly manage their disease.That commitment increases if you have to go to hospital. Surgery for anyone can be traumatic but it shouldn’t be any more traumatic for someone with diabetes, provided they are appropriately prepared.
The key is to be well informed, take an active role in your own management and plan well before the event.
Consult with your doctors
When you make the appointment, request that your procedure be scheduled first on the morning list, so your diabetes routine is disrupted as little as possible.
Talk to your diabetes team about the surgery/procedure and what to expect. It is also the ideal time to discuss liaison between your endocrinologist (diabetes specialist) and the surgical team.
Discuss with your medical team (including your diabetes educator) any concerns you may have regarding the procedure and your diabetes management plan before, during and after surgery. You may have questions about fasting, when you can eat and modifications to your insulin dose.
Most hospitals have a protocol for managing people with diabetes undergoing surgery; however, it is advisable that the surgical team is made aware of your individual management plan.
Changes to your insulin and diabetes tablets, particularly metformin, are often required before and after day procedures or surgery. You may be taken off oral type 2 agents and put on insulin.
Be prepared for the possibility of having a ‘hypo’ while you are in hospital, so ask your specialist or educator what precautions you can take and acceptable treatments that would be used.
The day before the surgery/procedure
Test your blood glucose levels at least four times on the day before the surgery. Because you will not be eating breakfast on the day of the surgery, you may need to adjust your insulin dose the night before. Oral medications will be stopped if you are fasting and some, like metformin, may be stopped 2-3 days before the surgery.
People with type 1 diabetes need to inform the medical/surgical team if they have ketones in their urine prior to surgery.
The hospital stay
When you go to hospital, take all your current medications with you. An alternative is to have a list with you of all the medications, how much and how often you take them.
The type of insulin you use and the dosage may be changed while you are in hospital. You may be given intravenous insulin to control your blood glucose levels if they are high.
It’s important to maintain good blood glucose control. A number of recent studies have shown that patients who have good control while they are in hospital have better health outcomes with fewer infections and problems.
Following the surgery/procedure
Discuss the best ways of managing your recovery with your doctor or the person looking after the procedure.
When you are discharged, make sure you know what changes have been made to your diabetes management and whether to continue these changes or to revert to your original treatment plan.
Careful planning, being well prepared, well informed and telling all the right people what they need to know will help make your hospital stay more comfortable and put you on track for a safe and speedy recovery.