Plastic Surgery for Diabetics: What Are The Risks?

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


July 03 2008

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Managing Surgery for Diabetics

Diabetics have long been considered poor risks as surgical patients, which means they may be turned down for elective procedures like cosmetic or weight loss surgery. But with careful management of their disease, diabetics can become viable candidates for the operating room.

Diabetes mellitus is a disease in which the body does not produce or properly use insulin, a hormone made by the pancreas that is needed to convert sugar, starches, and other food into energy. As a result, too much glucose (sugar) remains in the blood; at elevated levels (known as hyperglycemia) the glucose spills into the urine. At high levels of blood glucose, body cells become starved for energy; over time, high glucose levels can damage nerves, eyes, kidneys, the heart, and blood vessels. It can also lead to premature death.

Seven percent of the United States population – 20.8 million children and adults – have diabetes, and nearly one-third of them (6.2 million) don't know it, according to the American Diabetes Association. The cause of the disease isn't totally understood, but both genetics and environmental factors, including obesity and lack of exercise, are thought to be involved.

There are four major types of diabetes. The two most common are Type 1 (previously called juvenile-onset or insulin-dependent diabetes) and Type 2 (often referred to as adult-onset or non-insulin-dependent diabetes). The first occurs when the body fails to produce insulin and affects up to 10% of Americans who are diagnosed with diabetes. Type 2 diabetes results from insulin resistance (when the body fails to properly use insulin) or an insulin deficiency (the body doesn't produce enough). The vast majority of American diabetics fall into this category. Gestational diabetes affects about 4% of all pregnant women in the United States. It generally reverses itself after the baby is born, but the mother is at greater risk of developing diabetes at a later date. Finally, it is estimated that 54 million Americans are prediabetics, a relatively new category of people whose blood glucose levels are higher than normal but not high enough for diagnosis of Type 2 diabetes.

Diabetics are susceptible to circulatory issues that hamper healing of a wound or cut. This is one of the primary issues that arise when diabetics face any type of surgery, including cosmetic surgery. "People with diabetes also have a higher risk of cardiovascular disease, thromboembolic events like deep vein thrombosis and pulmonary emboli, and infection," says John Buse, MD, PhD, President, Medicine and Science of the American Diabetes Association. "Well-controlled patients with diabetes tend to be lower risk than they would be if they were not well controlled."

Prior to surgery, surgeons should evaluate the patient's situation and blood work to determine if he or she is a good candidate for surgery. Some of the things they consider besides well-controlled blood sugar and blood pressure are cholesterol levels, any existing medical complications, whether they've had a recent stress test, and any known vascular disease.

"Those kinds of things would be reviewed by the surgeon, anesthesiologist, and collaborating internist, usually a primary care provider, endocrinologist, or cardiologist," explains Dr. Buse. "It's optimal that everybody involved in the patient's care be aware of the plan." He recommends that diabetics make plans for elective surgery with their doctors well in advance to make sure everything is under control before the operation.

The physical stress of surgery can cause deviations in blood sugar levels, and high levels can impair healing. Careful monitoring of blood glucose to keep it within the normal range (80 to 120 mg/dl) is required before, during and after surgery for an optimal outcome.

Dr. Buse cites one study done in Belgium that involved postoperative cardiac patients who were also diabetic. The results indicated blood glucose readings of 105 to 110 were at the top of the acceptable range. "It suggested that very aggressive glucose control in the postoperative period is associated with better outcomes," he reports, adding that other medical professionals have suggested that a reading of 140 to 150 is a more reasonable expectation. "But, in general, most people believe that at least fairly good blood glucose control is important for optimizing outcomes postoperatively as well."

Going into surgery, Dr. Buse recommends readings in the normal range of 80 to 120, if not lower. "If someone is doing well and you can tighten up their blood sugar control for a few weeks before surgery, it at least holds the potential to minimize the risk of complications," he concludes.