Ask D’Mine: Healing with Diabetes, BG Control During Surgery

Got injuries? Have a hospital stay coming up? Add diabetes to the mix, and you can have a mess on your hands.

This week’s edition of Ask D’Mine, is on it.  Take a gander at what our host, Wil Dubois — diabetes author, community educator and veteran type 1 — has to say on these topics.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Nikki from California, type 2, writes: I have a question about healing as a diabetic. It’s been about 3 months since I broke my ankle and sprained my foot. I’ve healed, but still seem to have limited movement, and trouble walking and standing for a long period of time. I am doing therapy twice a week, but still sore. Is it possible that my diabetes is stopping the healing process? What can be done to help that?

Wil@Ask D’Mine answers: There’s a long-held mythology that we PWDs heal slowly; but it’s not true. Well… not necessarily true.

OK, some D-folk do heal slowly: those with crappy blood sugar control. Crappy Blood Sugar Control (also known as CBSC in medical research circles) messes up the smallest hoses in you circulatory system’s pipeline — the capillaries. This is why people with Extremely Crappy Blood Sugar Control (or ECBSC  ), end up getting toes, feet, and legs cut off. Scares the hell out of me, but every day 180 PWDs get “nontraumatic” lower-limb amputations, according to the latest CDC data. I guarantee you that any amputation is traumatic, but what they’re saying is these were medically necessary amputations, instead of ones caused by some traumatic injury—like running over your foot with a lawn mower or wiping out your motorcycle wearing cut-off jeans on a gravel road.

Both capillaries and nerves come into play, but the bottom line is that folks with high blood sugars end up with the killer combo of poor circulation and poor sensation. They don’t feel injuries and they don’t heal normally. That sets them up for disaster, because if you don’t know you just stepped on a nail (it really happens), you don’t treat it until waaaaaaay too late. Meanwhile, the reduced circulation makes it harder for oxygen and germ-fighting white blood cells to get to the scene of the injury.

So now that I’ve ruined your morning coffee and bagel, let me get back to your question—is it possible your diabetes is stopping your healing process? No. Absolutely not.

But maybe you asked the wrong question.

Is it possible that your blood sugar is stopping the healing process?

Hell yeah. It sure could be. If it’s high.

What can be done? Simple. Fix your damn blood sugars.

If you blood sugar isn’t where it should be, get it there. Now. Call your doc. Maybe you need a med increase. Maybe you need a new drug. Maybe you need to re-evaluate your diet. Your activity.

Bottom line: diabetes doesn’t really cause much of anything. It just makes it… ummmm… challenging to keep your blood sugar in a normal range. It’s high blood sugar that’s the secret killer which can mess you up from top to bottom, stem to stern, side to side. High blood sugar is like battery acid in your blood.

To control your blood sugar is to control your health destiny.

Dena from Wisconsin, type 2, tells us: I’ve been recently put on insulin, and have to have knee surgery soon. Do I inject before and after surgery? I’m scared about having the hospital staff do the injections, because I’ve heard horror stories about mistakes…?

Wil@Ask D’Mine answers: In the old days many hospitals had a quote  posted over the front doors that said Lasciate ogne spernza, vio ch’intrate. In some places it was carved into the marble lentil, at other hospitals it was written in large gilded brass letters that were bolted to the wall. I’ve seen at least one hospital where it was beautifully installed on the entryway floor using custom tile. Most people thought it was a quote from Hippocrates or some other great mind of medicine.

Nope.

It’s Dante. And the Latin translates into “Abandon all hope, ye who enter here.” Nowadays, of course, you only see this quote at the billing office.

Hopefully, by now you’ve figured out that I’m just pulling your leg (gently, of course, as not to injure your knee any further). But there’s a grain of truth here too. Entering a hospital entails abandoning, if not all hope, at least all control.

When it comes to your body and your meds, you lose all control when you walk in that door, whether or not the friendly Latin saying is announcing it. The hospital is in the driver’s seat. They’re the boss. It’s a prison and you are their, well, you know…

In this circumstance I can’t tell you when and how to take your insulin. Neither can your doctor, for that matter. Remember who’s in charge? That’s right. The hospital rules. So their rules rule. The hospital will give you a written medication instruction sheet in advance of the surgery that you’ll have to sign. This generally takes place at an appointment called a pre-op conference. And I’d actually expect all sorts of other weird start-and-stop-and-start orders on all of your various meds before you go in, not just your insulin. Why? Well, for instance, some meds reduce clotting factors. Your surgeon sure as hell wants any of those out of your system before cutting you open; he doesn’t want you bleeding to death on the table—your family might sue the Armani pants off him.

Also, some prescriptions are contraindicated with some types of anesthesia (that means it would be a really, really bad idea to have both of them in your body at once). Further, the diabetes med Metformin doesn’t play well with contrast dye, so if you need some imaging as part of the procedure, the Met might be stopped for a while. Blood pressure meds might need to be tinkered with, and so on.

Actually, in my experience, hospitals do a pretty darn good job of telling you when to stop your meds before surgery. Where the ball tends to get dropped is on the other end, after folks leave the hospital. Patients are often left unclear on when to restart their various medications, sometimes with tragic consequences. But that’s a post for another day because what you’re really worried about is the nurses on the floor adding you to the list of horror stories.

You can try to get “self-administration” of insulin written into your orders in advance of the surgery, but good luck with that. On top of being in control, hospitals tend to be control freaks. Still, it never hurts to have your doctor ask.

The bottom line is that before the operation you have to do what they tell you to do. Period. But once you are out of recovery and on the floor, you can stand up for yourself.

A little bit.

Nurses know a lot; but think they know everything. So you can see where this is going. Unfortunately, the typical nurse doesn’t get much training in the area of diabetes. My advice is to stand up for yourself in a very friendly passive-aggressive manner. Just tell the nurses something like, “I can see that you’re an exceptional nurse, and I feel like I’m in really good hands here; but I saw this story on Dr. Oz where this diabetic was given too much insulin and it really scared me. Please don’t be insulted, but I’d just rest so much better if I just doubled checked that syringe before you sick me with it.…”

My advice is to be sweet. You know, more flies with honey than vinegar, right? Nurses can have fierce egos. On top of the fact they tend to be overworked and under-appreciated, especially in hospitals.

Be nice to the nurses, and nurses will be nice to you.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.