My mom is scheduled to have a complete hysterectomy, and I am nervous because she has diabetes. I am concerned about the healing process. Secondly, she has asthma and is fearful of the tube being put down her throat. The doctors are also repairing her bladder which the uterus is falling on. The doctors have scheduled her surgery at 11:00 am, and I’m afraid that might affect her blood sugar. Do you have any suggestions I might propose to the doctor beforehand?

It is better for surgery to occur early in the morning for patients with diabetes. I would have to say that for reasons of scheduling and convenience, this practice has fallen off. I would check with your mother’s physician to see what recommendations they have for her care. An additional issue is that there will be an anesthesiologist following her during the surgery. They will probably see her early before the surgery and manage the sugar during the early hours.

For patients with type 1 diabetes, there is no question that they have to have insulin, even if they can’t eat anything. If not, patients with type 1 diabetes could go into DKA [diabetic ketoacidosis].

For patients with type 2 diabetes, they could be on a variety of treatments. If your mother is on oral hypoglycemic agents, they may have her hold her medications and check her sugar before surgery. If she is on insulin, I prefer to give some of the long-acting insulin before the procedure.

It is a given that the sugar will rise because of the stress of the surgery. I recommend the sugar be kept less than 200 mg/dl [11.1 mmol/L] at all times to minimize infection and assist healing. Values less than 150 mg/dl [8.3 mmol/L] are even better. Of course, there is a need to prevent lows. This can usually be done by giving a variable infusion of glucose during the post-op period while patients are still not eating.

JTL

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

SS]