Diabetes can be part of the cause for increased risks for patients undergoing surgery. When compared to patients without diabetes, the numbers of patients developing an infection around their operation is higher, and the amount of time patients stay in hospital is longer, in patients with diabetes compared to those without. Ensuring your diabetes is as well controlled as it can be, is one way to reduce these (and other) risks.
After your operation, we will aim to facilitate and support eating and drinking as soon as possible.
Before your operation
HbA1c:
- HbA1c is a blood test that measures the average blood sugar in your body over the preceding 2-3 months
- It is a useful measure of diabetic 'control' and is often carried out annually by the team managing your diabetes (GP/Community Team/Diabetic Specialists).
- There is evidence that patients with a HbA1c lower then 69mmol/mol have better recoveries, shorter hospital stays, and less chance of a significant complication.
- For this reason, we aim for patients with diabetes to have a recent (less then 6 months old) HbA1c of less then 69mmol/mol
- If you have not had a HbA1c test performed in the last 6 months, asking the team who manage your diabetes for one when you have been told you may need surgery can be helpful. If not performed, we will repeat it at your POAC appointment.
- Occasionally more urgent situations mean you may undergo surgery with higher HbA1c levels.
Medications:
- Please see the Medicines page for detailed information. We aim to interfere as little as possible with your diabetic regime through your hospital stay, however this is not always possible. Some medications, for example Insulins and Flozins may require changes to doses, or withholding entirely.
- Oral Diabetic Medications: Certain types of drugs may need to be stopped before your operation - for example Flozins (SGLT2i- Sodium Glucose Cotransporter 2 inhibiting class drugs) such as Dapagliflozin, Empagliflozin or Canaglifozen. These are generally stopped the day before your operation, and won't be restarted until you are eating and drinking afterwards. (This helps to prevent a complication called Euglycaemic Ketoacidosis).
- Insulin: Doses will need to be adjusted on the day-of, and night-before operations depending on the regime you are taking. Generally at least some of your longer acting insulin will continue as a background buffer.
- The POAC Nurse or Pharmacist will explain what adjustments you should make before your operation when you are seen in clinic - please see our Medicines page
- If you do not have a clear plan for how to manage your diabetic medications leading up to your operation, please contact the relevant POAC (UHW 029 2074 4775 or UHL 029 2716 6163)
During your admission
- Where possible, you will be placed first, or towards the start of the operating list (morning / afternoon) - this is to reduce fasting times and their impact on your diabetic medication regime.
- During your admission, surgery and recovery, you may experience more erratic blood sugar levels, and may need larger doses of your current medications or others to be started
- This is made worse by the 'stress' your body experiences during and after the operation
- Fasting before, and delays in resuming normal oral diet afterwords can make it more challenging to manage your diabetes/blood sugars, and you will often need closer monitoring and control of your diabetes through this period, this may be a continuous insulin infusion
- Some operations (such as head and neck surgery) may mean you will be unable to eat or drink for a few days after the operation, and we may need to commence an insulin infusion for this period to control your blood sugars.
Blood Sugar Targets:
- We will monitor these closely where required, and aim to keep your blood sugars below 12 mmol/L whilst avoiding hypoglycaemias
- You should feel empowered to have as much influence, information and control when considering all aspects of your care, but particularly long term diabetes management, please ask medical staff at any point of your stay, you may also be looked after by diabetic nurse specialists.
After your operation
Before your discharge, you will be provided with medication, prescriptions/plans and information for how to manage your diabetes whilst you recover at home.
My Diabetes Passport
"My Diabetes Passport" is a comprehensive booklet designed for patients with Diabetes undergoing surgery that's been adapted for use in Cardiff. It can be accessed below, or will be given to you at your POAC visit. Please bring it with you to all POAC and surgical clinic visits when preparing for your operation, and also when you are admitted.
It helps us, and you, prepare and optimise your diabetes as much as possible, and takes you through every step of the process from before your operation, during your hospital stay, and returning home.
Other Resources for Diabetes