Healing After Surgery: Concerns and Expectations for People with Diabetes
For diabetics who eat well, exercise and have excellent blood sugar control, the incidence of post-surgery problems is not much higher than for non-diabetics.
The risk of slow wound-healing and post-surgical infection increases with years having diabetes, difficult to control or poorly controlled blood glucose, and the presence of diabetes complications such as neuropathy (nerve damage).
The possibility of slow wound-healing is owed to the effects of high glucose on blood vessels and nerves, and the risk of infection is greater when healing is slow.
Slow Healing, Sensitive Nerves and Infection
Post-surgical tissue repair requires our smallest blood vessels to carry nutrients and oxygen to organs and nerves. When these blood vessels are damaged by the effects of high blood sugar, the healing process is slowed, and our nerves get stressed.
If our nerves do not receive adequate oxygen they are forced to work harder, just as we breathe harder when the atmosphere is thin. The nerves become irritated which may cause prolonged or increased post-surgery discomfort. Constant irritation can damage the nerves.
When a surgical incision is slow to heal, bacteria have increased opportunity to enter and enjoy the nutrient rich sugar buffet inside our body. Severely damaged nerves may not register the pain and swelling caused by the bacterial invasion.
The potential for an infection increases if the incision is on an extremity such as a hand or foot, where blood vessel and nerve damage can be more severe.
Infection and High Blood Sugar
Once within our body, bacteria reproduce quickly and begin to spread. Fortunately, this intrusion alerts our immune system, and white blood cells are sent out to attack the bacterial foe. This is a mixed blessing since white blood cells also trigger inflammation that is damaging to our tissues.
Still, the white blood cell brigade is a formidable defense, but is weakened by high blood sugar. Elevated glucose causes the white cells to function like soldiers with insomnia, making them less effective at neutralizing bacteria. So, you have sluggish white blood cells attempting to fight in a high glucose situation that energizes the bacteria.
The best post-surgery antibacterial plan is - no surprise - good blood sugar management. Your surgical team should give you explicit post-surgery instructions to follow, and you will want to do the following:
- Keep tight control of your blood sugar level.
- Eat fresh, whole foods and high quality proteins; excellent nutrition can speed the healing process and helps prevent infection.
- Check regularly for signs of wound infection, especially if you have neuropathy; watch for pus or foul drainage, a fever above 101 F, increased pain around the wound, an incision that is painful, hot to the touch, swollen, or hardening.
- Practice relaxation techniques such as controlled breathing, journaling, listening to music, socializing, and begin exercising as soon as you get the doctor’s okay; worry and stress tend to raise glucose levels.
Surgery with Unsteady Glucose
Surgeons will generally put off elective surgery with people whose A1C readings are erratic. They prefer to know patients can control their glucose before putting them at risk of infection.
For those with type 1 diabetes and difficult to control glucose, surgery will require you to work closely with your diabetes care team, pre and post procedure, to manage your glucose as tightly as possible. The six weeks following surgery are the most critical.
In emergency or trauma situations, whatever your glucose track record, the surgical team will regulate your blood sugar using regular insulin until you can resume your usual management routine.
Source: Diabetes Health