Newsflash: Diabetes can be cured with surgery. Islet cell culture transplantation
Patients with diabetes are often forced to resort to surgical treatment due to a tendency to purulent-inflammatory diseases, disorders of innervation and blood circulation. A common problem is severe postoperative complications in diabetes mellitus.
Immune suppression, metabolic disorders and decreased pain sensitivity alter the course of many surgical diseases.
Surgery is a great stress for the body. Surgical trauma and anesthesia lead to depletion of adaptation mechanisms.
Classification of complications
| Not psychic sphere | Highlight:
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| Of cardio-vascular system | The risk of diabetes is high:
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| Respiratory system | Often occurs, especially in elderly patients:
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| Thromboembolic | High risk:
The frequency of this complication in diabetics is explained by pathological changes in the vascular wall in this disease. |
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| Digestive system | Not uncommon:
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| Urinary system | Meet:
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| From the liver | There are complications such as:
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| Endocrine disorders | Life-threatening complications after diabetes surgery:
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| From the side of the surgical wound | These include:
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Prevention
The primary task of the surgeon is to minimize the risk of postoperative complications.
Main events:
- Fighting nosocomial infections.
- Reducing the length of patient stay in hospital.
- Strengthening the immune system (vitamin complexes, balanced nutrition).
- Preliminary identification of chronic foci of infection. Old postoperative scars can pose a danger.
- Preventive antibiotic therapy before and after surgery.
- Use of high-quality suture material.
- Full examination (blood and urine tests, coagulogram, ECG).
- Timely detection and treatment of complications.
After surgery for diabetes, active management of the postoperative period is effective: getting up earlier, breathing exercises, physical therapy.
Features of surgical treatment
A postoperative period without life-threatening complications is possible only with full compensation of diabetes mellitus, since trauma and blood loss during surgery aggravate metabolic disorders.
Preparing the patient for planned surgery
Main goals:
- Correction of carbohydrate metabolism and normalization of blood glucose levels.
- Stabilization of water and electrolyte balance.
- Elimination of fat metabolism disorders.
- Treatment of concomitant diseases.
- Creation of glycogen depot in the liver. For this purpose, infusions of glucose and electrolyte solutions are performed.
Attention! On the day of surgery, it is necessary to monitor blood sugar levels every 2-3 hours!
Shown:
- 2-3 days before surgery - transfer to simple insulin.
- Patients should receive a nutritious diet, including a sufficient amount of carbohydrates and at least 1.5 g of protein per 1 kg of body weight.
- It is advisable to maintain glycemic levels slightly above normal.
- If surgery for diabetes mellitus lasts more than two hours, an urgent blood glucose test is required.
Patients with diabetes should be operated on in the morning! On the day of surgery - infusion of 5% glucose under control of blood sugar levels.
Urgent Care
In emergency cases, the surgeon faces a difficult task: it is necessary to quickly make a diagnosis, decide on the type of surgical intervention, and carry out preoperative preparation. In addition, approximately 25% of patients are unaware of their disease. Compensation failure can occur at any stage of the operation and lead to a life-threatening condition.
Upon admission of a patient with acute surgical pathology, an urgent blood and urine test for glucose!
In this case, the following activities are carried out:
- Infusion therapy is indicated to eliminate hypovolemia and correct electrolyte balance.
- After receiving the test results, administer simple insulin.
For health reasons, emergency operations are also performed when there is a high level of glucose in the blood, but this poses a great danger to the patient.
Postoperative wounds
A big problem is the slow healing of wounds after surgery for diabetes mellitus, since the disease inhibits recovery processes. Regeneration disorders lead to the appearance of purulent-inflammatory complications.
In severe cases, recovery may take up to two months (with amputation of the lower extremities). The severity of the disease at the time of surgery is very important.
Factors slowing down regeneration processes
Has the meaning:
- metabolic acidosis on the first day after surgery;
- elderly age of the patient;
- obesity in most patients with type 2 diabetes;
- reduced immunity;
- peripheral circulatory disorders;
- excess corticosteroids due to improper functioning of the adrenal glands.
According to statistical data, the nature of the surgical intervention affects the healing time. During planned operations, purulent-inflammatory complications occur less frequently than during emergency operations.
Sugar-lowering therapy is also of great importance: with a decrease in the dose of insulin, deterioration of the patient’s condition and wound suppuration were often observed.
Features of treatment
Basic principles of therapy and postoperative care:
| Stabilization of the patient's condition | Applicable:
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| Local treatment, creating favorable conditions for regeneration | Promotes rapid healing:
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| Antibacterial therapy | Broad-spectrum antibiotics are used. In the presence of purulent discharge from a wound, culture for bacterial flora and sensitivity to antibiotics is required. The most effective drugs: Ciprofloxacin, Tazocin. The use of these antibiotics allows you to shorten treatment time and avoid side effects. |
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Surgical treatment of diabetes mellitus
Despite the successful treatment with insulin in many cases, the mortality rate and number of complications in diabetes mellitus continues to increase. Great hopes are placed on the development of surgical methods for treating the disease.
Surgery on the pancreas for diabetes mellitus is a chance of recovery for the most hopeless patients.
Main directions:
- pancreas transplantation;
- transplantation of donor cells of the islets of Langerhans that produce insulin.
Pancreas transplant
To perform surgery, donor material is required.
Depending on the volume of the operation, there are:
- total (full) transplantation;
- segmental;
- pancreas and kidney transplant.
Such an operation is very dangerous for the patient, especially in cases of severe disease and complications. Disturbances in the cardiovascular and excretory systems can provoke donor organ rejection and deterioration of the condition.
Disadvantages of organ transplantation:
- complexity of surgical intervention, high risk of postoperative complications;
- the need for immunosuppressive therapy (steroids used in this case have a diabetogenic effect and also increase the risk of developing malignant tumors;
- high mortality rate;
- After 1-2 years, the transplanted pancreas stops producing insulin in the required volume.
Islet cell culture transplantation
This method is technically simpler. Can be used for type 1 and type 2 diabetes. To do this, cells are extracted from the tissue of the donor gland using special enzymes and implanted into the recipient.
Places for islet culture transplantation:
- muscles, liver, kidney capsule, spleen;
- red bone marrow;
- blood vessels.
The cells begin producing insulin almost immediately after transplantation, but without suppressing the immune reaction of rejection, the effect may be short-lived. Currently, scientists are looking for a way to maintain the activity of transplanted cells without the use of immunosuppressants.
Further development of surgical methods for the treatment of diabetes mellitus will help improve the quality of life of many patients and prevent the development of severe complications.
Frequently asked questions to the doctor
Plastic surgery for diabetes
Good afternoon, doctor! I am 42 years old. Since childhood, an insulin syringe has been my constant companion. As I grew older, problems with my kidneys appeared and my vision deteriorated significantly; I even had to undergo surgery. I am interested in the following question: is it possible to have breast augmentation surgery if you have diabetes? After 40 years, my figure has changed for the worse and I would like to improve something.
Hello! Due to the high risk of developing postoperative complications, surgical interventions are desirable only for health reasons.
Can diabetes be completely cured?
Hello! I read on the Internet that diabetes can be treated surgically. Is it true? What could be the consequences?
Good afternoon Surgical treatment for this serious disease is possible. Pancreas transplantation and replacement of the islets of Langerhans with a donor cell culture will help overcome diabetes mellitus; the consequences after the operation depend on many factors. These include: the surgeon’s qualifications, the patient’s condition at the time of surgery, and the presence of concomitant diseases.
Diabetics, like all healthy people, are not immune to the need for surgical intervention. In this regard, the pressing question arises: is it possible to have surgery for diabetes?
Diabetes mellitus is a chronic disease, which is characterized by impaired functionality of metabolic and carbohydrate processes in the body. The insidiousness of the pathology lies in the fact that it is fraught with numerous complications.
Patients with diabetes suffer from the same surgical diseases as other people. However, they have a greater tendency to develop purulent and inflammatory processes; after surgery, the course of the underlying disease often worsens.
In addition, the operation can provoke the transition of a latent form of diabetes into an overt form, and prolonged administration of glucose and glucocorticoids to patients has an adverse effect on defective beta cells. That is why, when an operation is indicated, there are a lot of nuances in its implementation, and there is a certain preparation.
It is necessary to consider how diabetes mellitus and surgery are combined, and what conditions are necessary for intervention? What is the preparation for the procedure, and how does the patient recover? You also need to find out what is surgical treatment of diabetes?
Surgery and its principles in relation to disease
It is worth saying right away that the pathology itself is in no way a contraindication to surgical intervention. The most important condition that must be met before the procedure is compensation for the disease.
It is advisable to note that operations can be divided into complex and easy. Easy tasks include, for example, removing an ingrown toenail or opening a boil. However, even the most minor surgeries for diabetics must be performed in a surgical setting and are not performed on an outpatient basis.
Performing elective surgery is prohibited if there is poor compensation of diabetes mellitus. Initially, it is necessary to carry out all measures that are aimed at compensating for the underlying disease. Definitely, this does not apply to those cases where the issue of life and death is being decided.
Diabetic coma is considered an absolute contraindication to surgery. First, the patient must be brought out of a serious condition, and only then the operation must be performed.
The principles of surgical therapy against the background of diabetes mellitus are the following:
- In case of diabetes mellitus, operate as early as possible. That is, if a person has diabetes, then, as a rule, surgical intervention is not delayed for a long time.
- If possible, move the operating period to the cold season.
- It provides a detailed description of the course of pathology in a particular patient.
- Since the risk of infectious processes increases, all interventions are carried out under the protection of antibiotics.
Characterization of the disease before surgery involves compiling a glycemic profile.
Preparatory activities
Sugar level
Diabetes mellitus in surgery is a special case. Every diabetic undergoing surgery, especially urgently, must take a blood glucose test.
Diabetics need hormone injections before surgery. The treatment regimen with this drug is standard. During the day, the hormone is administered to patients several times. As a rule, it is advisable to administer it 3 to 4 times.
If the course of diabetes mellitus is labile, or the case is too serious, then the hormone is administered five times a day. Patients' blood sugar is measured throughout the day.
Short-acting insulin is always used. Sometimes you can administer intermediate-acting insulin, but directly in the evening. This is based on the fact that before the intervention itself, the dose of the hormone will need to be adjusted.
Preparation for surgery includes a special diet, which is based on the surgical disease, as well as diabetes. When the patient has no contraindications, he is prescribed to drink as much fluid as possible.
Features of preparation:
- If after the operation the patient cannot return to a normal diet, then half the standard dosage of insulin is administered before the intervention.
- After 30 minutes, a glucose solution is introduced.
It is worth noting that anesthesia causes the human body to require more insulin than usual. This point must be taken into account before carrying out the operation.
Criteria for patient readiness for surgery:
- Normal blood glucose level. The norm in this case is 8-9 units. In a number of situations, indicators of up to 10 units are acceptable, this applies to those patients who have already been ill for a long period of time.
- There is no sugar or acetone in the urine.
- Decreased blood pressure levels.
On the eve of the intervention, glucose levels in the body are monitored at 6 am. If the patient has an increase in blood sugar, then 4-6 units of insulin are injected (sugar 8-12 units); when the sugar is extremely high, more than 12 units, then 8 units of insulin are injected.
Rehabilitation, anesthesia: features
For type 2 diabetes, there are certain conditions for the rehabilitation period. First, control your blood sugar several times a day. Secondly, taking glucose-lowering medications.
In type 1 diabetes, recovery without insulin is impossible. This may cause the patient to develop acidosis. And only in very rare cases is it possible to maintain normal blood sugar levels in this category of patients.
Insulin is administered in small portions of no more than 8 units, several times a day, plus a 5% glucose solution. It is necessary to do urine tests every day, since the possibility of the appearance of ketone bodies in it cannot be ruled out.
On approximately the sixth day, provided that the patient has been stabilized and diabetes mellitus has been compensated, he can be transferred to the usual regimen of hormone administration, that is, the one he followed before surgery.
After surgery, the patient can be switched to sulfonylurea medications, but after 25-30 days. Provided that the healing went well, the stitches did not become inflamed.
Features of urgent intervention:
- It is difficult to calculate the dosage of the hormone, so it is selected individually, based on blood and urine tests.
- Blood sugar control also occurs during surgery if it lasts more than two hours.
It is worth noting that in patients with diabetes, the suture will take a little longer to heal than in ordinary people. Despite the high risks of developing inflammatory processes, with adequate therapy and following all recommendations, everything will heal. The healing suture may be itchy, but there is no need to scratch if the patient wants it to heal normally.
When performing anesthesia, it is very important to monitor the patient’s blood levels. Sugar may rise sharply, which will negatively affect further intervention.
Features of intravenous anesthesia: it is imperative to select an adequate dosage of the drug; it is acceptable to use local anesthesia for short-term surgery; you need to monitor hemodynamics, since diabetics do not tolerate a decrease in blood pressure.
For an intervention whose procedure will take a relatively long period of time, multicomponent anesthesia is most often used.
It is well tolerated by diabetics; sugar levels will definitely not rise.
It happens that a patient needs to be operated on urgently due to insufficient compensation for the disease. In this option, intervention is recommended against the backdrop of measures that will eliminate ketoacidosis.
This can be achieved if strictly adjusted doses of insulin are adequately administered to patients. The introduction of alkalis into the patient’s body is extremely undesirable because they provoke many consequences.
Patients may experience increased sugar, intracellular acidosis, lack of calcium in the body, arterial hypotension, and an increased likelihood of cerebral edema.
If the acid level is below seven, then sodium bicarbonate can be administered. It is necessary to ensure the necessary supply of oxygen to the body. Against this background, antibacterial treatment is recommended, especially at high body temperatures.
Insulin must be administered (fractionally), and the concentration of glucose in the blood must be monitored.
In addition, a long-acting hormone is introduced, but glycemic control is still maintained.
Diabetes surgery
Metabolic surgery is a method of surgical intervention that helps restore the functionality of the metabolic system. Based on numerous studies, “gastric bypass” deserves maximum attention.
If you perform such an operation for diabetes, you can normalize blood glucose to the required level, reduce excess weight to the required level, and eliminate overeating (food immediately enters the ileum, bypassing the small intestine).
Research and statistics show that surgical treatment of diabetes is quite effective, and in 92% of cases it was possible to relieve patients from taking medications.
The advantage of this method is that the procedure is not radical; surgery is performed through laparoscopy. This reduces the likelihood of adverse reactions and the development of inflammatory processes.
In addition, rehabilitation does not take a long period of time, the operation does not leave scars, and the patient does not need to be in the hospital for a long time.
The features of the procedure are the following:
- There are age restrictions for the procedure - 30-65 years.
- no more than seven years.
- Pathology experience no more than 10 years.
- Glycated hemoglobin is difficult to control.
- Body mass index over 30, type 2 diabetes.
As for the mortality rate, it is lower than that of “traditional” operations. However, this only applies to those patients who have a body mass index greater than 30.
Pathological changes in organs and tissues.
When doctors explain why surgery should not be performed for diabetes, they often refer to the fact that the disease makes the healing process slower and longer. Tissue regeneration plays a key role in how successful the procedure will be, so some people prefer not to take risks. However, this does not mean that a diabetic patient cannot undergo surgery at all.
There are cases when this cannot be avoided, and experienced specialists do everything to protect their patient as much as possible before a complex procedure. In this case, it is necessary to know exactly the conditions under which the operation can be performed, all the influencing factors and, of course, the features of preparation for the procedure.
Surgery for diabetes mellitus
Of course, those who suffer from diabetes, like each of us, may also be at risk of surgery. Life has different circumstances and, in some cases, surgery is the only option.
Doctors usually warn that with diabetes, the risk of possible complications is much higher.
Patients involuntarily wonder whether they perform operations for diabetes or would it be much more reasonable to do without them? In some situations, it is recommended to refrain from surgery, while in others this is not an option. In this case, the patient must be very carefully prepared for the upcoming procedure.
Preparing for surgery
Surgeries for diabetes mellitus are not easy. Not only the diabetic patient, but also the doctors themselves need to be seriously prepared.
If in the case of minor surgical interventions, such as removing an ingrown nail, opening an abscess or the need to remove atheroma, the procedure can be performed on an outpatient basis, then in the case of a patient with diabetes, the operation is performed strictly in a surgical hospital in order to eliminate as much as possible all possible negative consequences.
First of all, it is necessary to conduct a sugar test to make sure that the risk of surgery is not too high, and the patient has every chance of surviving the procedure and recovering from it.
The main condition of any operation is to achieve diabetes compensation:
- if a minor operation is to be performed, the patient is not transferred to;
- in the case of a serious planned operation, including opening the cavity, the patient is necessarily transferred to injections. The doctor prescribes 3-4 times the drug;
- It is also necessary to remember that after surgery you cannot stop taking insulin, since otherwise the risk of complications increases;
- if general anesthesia is necessary, the patient receives half the morning dose of insulin.
The only contraindication to the procedure, which is never violated, is diabetic coma. In this case, not a single surgeon will agree to perform the operation, and all the efforts of the doctors will be aimed at getting the patient out of the dangerous condition as quickly as possible. After the general condition has returned to normal, the procedure can be scheduled again.
- significantly reduce calories;
- eat food up to six times a day in small portions;
- do not eat saturated fats;
- significantly reduce the consumption of cholesterol-containing foods;
- eat foods that contain dietary fiber;
- Do not drink alcohol under any circumstances;
- check for lipid metabolism disorders and, if necessary, make corrections;
- Monitor blood pressure and adjust if necessary.
By following preparatory measures before surgery, the likelihood that the procedure will be successful increases. Careful monitoring of the patient allows for a favorable postoperative period, which is also important.
Plastic surgery
Sometimes circumstances develop such that there is a need or desire to use the services of a plastic surgeon.
The reasons may be different: correction of a serious defect or the desire to make any changes to the appearance.
Such procedures cannot always be performed on people without diabetes, but those suffering from it are a special case. The question arises: is it possible to have plastic surgery if you have diabetes?
Most likely, doctors will recommend refraining from surgery. Diabetes is a contraindication for many plastic procedures, since doctors do not want to take such a risk. You need to seriously think about whether the patient is ready to sacrifice safety for the sake of beauty.
However, some plastic surgeons agree to perform the operation provided that the diabetes has been sufficiently compensated for. And if, after carrying out all the necessary research, it can be confirmed that the forecasts are encouraging, then the procedure will be allowed to be carried out. In general, the main reason for refusing plastic surgery is not diabetes itself, but blood sugar levels.
Before undertaking plastic surgery, the surgeon will order a number of studies:
- endocrinological studies;
- examination by a therapist;
- examination by an ophthalmologist;
- biochemical blood test;
- blood and urine tests for the presence of ketone bodies (their presence is an indicator that metabolism is not proceeding properly);
- study of hemoglobin concentration;
- blood clotting test.
If all studies have been completed and the tests are within normal limits, the endocrinologist will issue permission to carry out the procedure. If diabetes is not compensated, the consequences of the operation can be very disastrous.
If you still need to decide on surgical intervention, it is worth conducting as much research as possible in order to protect yourself and promote better results. One way or another, each operation is a separate case that requires preliminary consultation and research.
Contacting an experienced specialist will help you find out all the specifics of the procedure and the list of tests that need to be taken in order to understand whether surgical intervention is permissible in a particular case.
If a doctor agrees to an operation without preliminary research, you should seriously think about how qualified the specialist is if he does not take into account many important aspects. Vigilance in such a matter can be a key factor in whether a person survives the procedure and whether everything goes well.
Postoperative period
This period, in principle, is monitored very carefully by doctors, since the entire further outcome depends on it. For diabetics, postoperative care is very important.
As a rule, the rehabilitation period takes into account the following important factors:- Under no circumstances should insulin be discontinued. After 6 days, the patient returns to the usual insulin regimen;
- control of daily urine to prevent the appearance of acetone;
- checking healing and absence of inflammation;
- hourly monitoring of sugar levels.
Video on the topic
We found out whether it is possible to have plastic surgery if you have diabetes. You can learn how they go from this video:
Is it possible to have surgery for diabetes mellitus? – yes, however, many factors need to be taken into account: state of health, blood sugar level, how compensated the disease is and many others. Surgical intervention requires careful research and a responsible approach to the matter. An experienced, qualified specialist who knows his business is indispensable in this case. He, like no one else, will be able to properly prepare the patient for the upcoming procedure and instruct what should happen and how.
The volume of surgical care for patients with diabetes mellitus is quite large. Approximately every second person with diabetes undergoes at least one surgical operation during their lifetime. Diabetes mellitus, especially in a state of compensation, should not be considered a contraindication to surgery.
The main condition for any planned surgery is to achieve diabetes compensation. Even minor surgical interventions (removal of atheroma, ingrown nail, opening of an abscess, etc.), which can be performed on an outpatient basis in people without diabetes, must be performed in a surgical hospital in patients with diabetes. Moreover, if a patient has stable compensation of diabetes while taking tablet drugs, during surgical interventions of this kind there is no strict need to switch to insulin. Patients receiving biguanides, in order to avoid acidosis and the development of lactic acidosis, should be transferred to insulin with the abolition of biguanides.
Before major planned abdominal operations, the patient, regardless of previous therapy, needs to be switched to insulin according to the usual rules for prescribing the drug. The patient is recommended 3-4 times (in severe labile forms of diabetes - 5 times) administration of simple insulin under the control of blood sugar and glycosuria during the day. The use of long-acting drugs before surgery is not advisable (an evening injection of intermediate-acting insulin can be allowed), as this complicates insulin correction. The diet should take into account the characteristics of the disease for which the patient is undergoing surgery. To prevent acidosis, especially in the period after surgery, fats should be limited in the diet; in the absence of contraindications, abundant alkaline drinks should be prescribed.
The regimen of insulin administration and nutrition in patients who are undergoing minor surgery under local anesthesia, which does not interfere with food intake, does not need to be changed. After administering insulin and breakfast, the patient is taken to the operating room, and after 1.5-2 hours he is given a second breakfast.
Patients who are undergoing abdominal surgery or any operation that excludes oral food intake, as well as patients undergoing surgery under anesthesia, should take approximately half of their morning dose of insulin before the intervention. 30 minutes after the insulin injection, 20 to 40 ml of a 40% glucose solution is administered intravenously, followed by a constant drip of a 5% glucose solution. Further administration of glucose and insulin is adjusted according to the level of glycemia determined every 2 hours. Metabolic stress accompanying general anesthesia and surgery usually leads to an increase in the need for insulin. The time of administration and dose of insulin is controlled by the sugar content in the blood and urine. Usually, until the patient’s condition is completely stabilized, simple insulin is administered 2 to 6 times or more per day.
It is unacceptable to discontinue insulin in the postoperative period in a patient who previously received insulin. This threatens the development of acidosis. In cases where normal glycemia levels persist during the day (very rarely!), patients are administered fractional doses of insulin (6-8 units 2-3 times a day) under the cover of a 5% glucose solution. During the postoperative period, patients are required to monitor daily urine (or several daily portions) for acetone.
After 3-6 days (sometimes more), provided the general condition is stabilized and diabetes compensation is maintained, the patient can be transferred to his usual insulin administration regimen. When it becomes possible to eat per os in the postoperative period, a mechanically and chemically gentle diet is prescribed and insulin treatment is continued. It is possible to discontinue insulin and transfer the patient to sulfonylureas 3-4 weeks after surgery, provided that the wound is completely healed, there are no inflammatory phenomena, diabetes compensation is maintained, and there are no contraindications for taking sulfonamides.
For urgent, emergency surgical interventions, it is difficult to give a specific insulin administration regimen. It is set purely individually based on the initial level of sugar in the blood and urine, subsequently monitored every 1-2 hours, as well as taking into account the daily dose of insulin received by the patient before surgery and the patient’s sensitivity to insulin in case of newly diagnosed diabetes.
Every patient undergoing urgent surgery should have their blood sugar levels checked!
In case of decompensated diabetes mellitus with signs of ketoacidosis, the patient should be operated on against the background of measures aimed at eliminating ketoacidosis, with fractional administration of simple insulin under glycemic control. If surgery can be delayed, ketoacidosis must be treated first. Patients who received long-acting insulin on the eve of urgent surgery may require (under glycemic control!) additional correction with simple insulin.
Diabetic coma is a contraindication for surgery. First, urgent measures are taken to remove the patient from a comatose state, and only after that can surgery be performed.
A.Efimov, N.Skrobonskaya, A.Cheban
“Preparation of diabetic patients for surgery” - article from the section
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