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May 30, 2003

Surgery

Question from Calgary, Alberta, Canada:

My 12 year daughter, who has type I diabetes, has just been diagnosed with scoliosis and may require back surgery. What are the increased risks as this type of surgery is serious and will force her to be inactive for up to a year?

Answer:

There is no particular reason why having type 1 diabetes should affect the outcome of scoliosis surgery. However, you will need to make sure that your daughter’s doctor is closely in touch with the surgical team over the control of blood sugar during and immediately after surgery. During convalescence too, control will be affected by stress, changes in appetite and especially from diminished activity. For these reasons, you might think to change, if you have not already done so, to a Humalog/Lantus (insulin glargine) insulin regimen which would offer almost as much flexibility as an insulin pump during and after recovery.

DOB
Additional comments from Dr. Stuart Brink:

If the diabetes is in reasonable control, the only risks would be related to the anesthesiology and are the same as for those without diabetes. Someone in the operating room and in recovery needs to be aware and knowledgeable about diabetes management pre- and post-operatively — or have consultation with the diabetes team who follows her care. Insulin adjustment and intravenous glucose as well as saline would likely be needed with frequent blood glucose monitoring pre-, during and post-operatively to guide insulin and fluid/glucose management.

If there will be less activity because she’s in a cast or bedridden for some period of time, expect the need for more insulin and/or less food. As in all other cases of diabetes, this must be individualized based upon frequent blood glucose monitoring but should not present very much of a problem with such monitoring and close contact with the diabetes team.

SB

[Editor’s comment: See Surgery Pre-Op Advice for some additional thoughts.

WWQ]