June 24, 2007
Question from San Diego, California, USA:
For many reasons, I've decided I want to go through breast augmentation surgery. I was wondering if the risks increase with type 1 diabetes? Also, how long would you recommend my sugars should be perfectly regulated before I go through this surgery in order for the risks of infections to be as lower as possible? What should my sugar be at the actual time of the operation? Lastly, in general, are there any repercussions, related to diabetes, of which I should be aware?
The fact that you would ask this question means that you are informed about the importance of blood sugar control to healing. Surgery causes a wound. In this case, it is a controlled wound. Blood sugars should probably be controlled for the month prior to the surgery, so you can practice good control, limit hypoglycemia, and be able to reproducibly control glucose values. After surgery, the sugars may rise and you will have to make adjustments, with your physician’s input, that help bring the blood sugars down. The sugars rise as a result of increases in the stress-related hormones as these hormones antagonize insulin’s effects. With type 1 diabetes, it is important that you speak with your physician concerning your insulin dosing up till the time of the surgery. Omitting insulin on the day of surgery is not an option. Some insulin needs to be given. Some hospitals give intravenous insulin during the surgery and through the immediate post-operative period to control glucose levels vigorously. This takes the form of an I.V. solution with insulin dripping continuously into the I.V. with frequent (every hour) blood sugar determinations. Care is needed in restarting insulin following surgery as food intake is often down. Glucose levels should be maintained less than 150 mg/dl [8.3 mmol/L] with some advocates suggesting even lower levels. As you can tell, this is an important process to walk through with your physician.