Cosmetic surgery and diabetes

05th Aug 2016

Diabetes is a common condition among the United States population. There are actually two types of diabetes: type 1, where patients require insulin, and type 2, which can be controlled with diet as well as oral medication. The metabolic impact of surgery, fasting, and interruption of glucose therapy contributes to poor glucose control, which in turn can significantly increase mortality, morbidity, and length of stay in patients with diabetes. Patients with diabetes have a higher incidence of complications after surgery, so the reason for maintenance of blood sugar during the surgery is to decrease the adverse outcomes related to this condition. High blood sugar or hyperglycemia is associated with an increase of adverse outcomes in hospitalized patients with both medical and surgical conditions, whether the patient is known to have diabetes or not. There is a strong correlation, and studies have shown that having high blood sugar during the surgical procedure increases complications following surgery, including infection. Blood sugar control during the first day after surgery helps prevent infection. In addition, diabetic patients are more prone to what is called nosocomial infections, which are infections that are actually acquired while you are at the hospital. Treatment of postoperative high blood sugar reduces the risk of adverse outcomes. Prevention of high blood sugar also reduces the risks of postoperative complications from any surgery.

Another surgical implication is that diabetics, like any other patient, need to fast before surgery. If a patient has what is called diabetic gastroparesis, it may result in delaying gastric emptying and subsequently aspiration after surgery, pneumonia, and death. In addition, gastroparesis may result in persistent nausea or vomiting with consequences such as delaying resumption of oral intake. There is no question that surgery may also precipitate heart ischemia or attack. One of the things we all need to look out for is that a patient with diabetes can actually have a silent heart attack, where there are absolutely no physical symptoms,.

If you have diabetes, it is not a contraindication of having cosmetic surgery. It will all depend on your preoperative levels, including HCB 1, as well as other factors that your surgeon needs to take into consideration before surgery. You need to have your glucose very well controlled. As a matter of fact, if you are overweight, you might be one of the 20% of diabetics who do not even know it. This is the reason that I always check the glucose in patients who are at high risk of having diabetes before any cosmetic surgery. You might be diabetic and not know it. If you have diabetes that is not controlled, your cosmetic surgery needs to be delayed. Cosmetic surgery is not a necessary procedure, so it is important to delay until blood sugar is controlled.

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