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Surgery & Glucose Levels
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What you need to know before you have an operation
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By Kalia Doner
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Diabetes Focus First Quarter 2007
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If your glucose levels are high before you go in for surgery, you may have an increased postsurgical risk for blood clots, deep vein thrombosis and pulmonary embolism (a blood clot in the lungs). Boris Mraovic, M.D., from the Artificial Pancreas Center at Jefferson Medical College in Philadelphia, and his colleagues looked at the records of almost 6,500 hip- or knee-replacement-surgery patients in that facility between 2003 and 2005. About 10 percent of those who had high glucose levels went on to develop a pulmonary embolism—that’s six times greater than the incidence seen in the general population. “The data suggest that if an individual has high blood glucose and is coming for surgery, he or she should correct it first and if possible postpone the surgery,” Dr. Mraovic says.
Unfortunately, he says, around a quarter of all surgical patients enter the hospital with elevated glucose levels. And intensive care and cardiac care patients with elevated glucose may run into added medical problems. Dr. Mraovic does caution that this study is preliminary: What’s needed to confirm the findings, he notes, is a randomized trial of incoming patients. But in the meantime, if you are headed for surgery, talk to your doctor about making sure your glucose levels are in good control. It certainly can’t hurt your postsurgical outcome—and it may help.
Repeat one more time: “Preventing diabetes is a team effort!” Here’s who can lend a hand—and proof that lifestyle changes work
Changing the habits of a lifetime is difficult; for people with prediabetes, glucose intolerance or metabolic syndrome who are told to make radical adjustments in their diet and level of physical activity, it can seem almost impossible. Well, it’s time to ask for help. That help might come from a doctor, diabetes educator, nutritionist and/or diabetes nurse practitioner.
The Finnish Diabetes Prevention Study let researchers in Finland look at the health of participants over many years. They found that when people had ongoing counseling about how to eat right, exercise and make other lifestyle changes, the frequency at which they went from glucose intolerance to diabetes was cut by an amazing 43 percent. Reporting their results in The Lancet, the researchers noted that once counseling stopped, the group that had received the support kept a 36 percent reduction in their risk of developing diabetes.
Complementing these findings, an article in Diabetes Care looked at results from the Diabetes Prevention Program and singled out weight loss as the lifestyle change most effective in preventing diabetes. For every kilogram (about 2.2 pounds) of weight that a study participant lost, his or her chance of developing diabetes was cut by 16 percent. Even among those who didn’t reach their weight-loss goals, cranking up their level of physical activity to meet the program’s standards cut the risk for diabetes by as much as 44 percent.
The European commission recently approved insulin aspart, an insulin analog, for use by pregnant women, making it the first insulin specifically recommended for pregnant women. This happened after a four-year trial of insulin use by 322 pregnant women with type 1 found that: 1) insulin aspart improved blood glucose control in the first and third trimesters; 2) it resulted in fewer preterm deliveries; 3) it reduced the risk of a newborn having hypoglycemia and needing treatment; and 4) it cut risks to the fetus, with outcomes at least comparable to human insulin.
Other news: At the 42nd European Association for the Study of Diabetes conference, researchers reported that switching from human insulin to analog insulin therapy that includes insulin detemir improves glucose control and reduces nighttime lows without weight gain. Insulin detemir, a long-acting insulin analog, can be used alone or in combination with oral diabetes medications and other insulins, including inhaled insulin.
The Diabetes Aware Generational Survey, commissioned by Novo Nordisk, found that older is wiser when it comes to checking glucose levels. While 55 percent of respondents age 18 to 40 said they check blood glucose regularly, 82 percent of those 60-plus reported doing so.
Insulin resistance and chronically elevated blood sugar levels have consequences beyond well-known diabetic complications such as heart disease and nerve, kidney and eye damage. Researchers at the Institute of Oncology in Israel’s Sheba Medical Center found that up to 16 percent of breast cancer patients have diabetes; they suggest that in those with diabetes, the action of insulin and sex hormones in the body, as well as the activation of the insulin-like growth-factor pathway, may account for the added risks. They found that having type 2 may increase one’s risk of developing breast cancer by 10 to 20 percent. Gestational diabetes—but not type 1—may also be associated with higher risk. Moreover, diabetes and its complications can adversely affect cancer therapy and the use of screening.
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