As a diabetic, wounds on my legs heal very slowly. Will this happen with other operation wounds also? I am worried about a proposed gall bladder removal operation.

 

In patients whose diabetes is under good control and who do not have complications from it, wound healing is generally fairly normal, especially in young people. On the other hand, when diabetes is poorly controlled and when it is accompanied by chronic complications, wound healing can be significantly impaired.

The long-term complications of diabetes occur due to damage to blood vessels nourishing the tissues or organs of the body. The skin is one of these organs and although skin disorders due to diabetes are not common, they can and do occur. The body’s ability to heal a wound depends upon healthy blood supply, which is needed to deliver nutrients to the cells that provide protective defence against infection and those that cause inflammation. In this sense, inflammation is beneficial in that it leads to removal of dead and damaged tissue, which paves the way for its replacement by new healthy healing skin and underlying tissue. Short-term high blood sugar paralyses blood and tissue defence, so that their infection-fighting and inflammatory activities are much weaker. Insulin itself stimulates healing and regenerative activities in body tissue. If diabetes is poorly controlled, this suggests that insulin is insufficient or ineffective, which can further impair healing.

For these reasons your doctor will try to help you get your diabetes under the best possible control before you go in for a non-emergency operation. If you have chronic complications from your diabetes, special attention should be paid to measures that will help your surgical wound to heal, such as ensuring adequate blood supply by keeping the area warm and not placing excessive pressure on it, and meticulous attention to the avoidance of infection. Your blood glucose will also be carefully controlled immediately following surgery.

If the diabetes has been neglected, it may be necessary to postpone the surgical procedure long enough to bring the diabetes under better regulation. If you have any concern about your diabetes, or have not seen your physician for some time, inform your surgeon so that an outpatient evaluation of diabetes and your general health can be arranged.

For people undergoing day surgery (surgery without being hospitalised), it is important to know how to manage your diabetes in anticipation of that event. You will need to know whether you must not eat before surgery and if so, for how long, what time the operation will take place, how long it will take, and how long it will be before you can eat again after surgery. Under no circumstances should you omit your insulin altogether unless your operating surgeon tells you to.

Dr Asok Cheriyan is specialist diabetologist at Al Waha Clinic Diabetes Centre, Dubai. Got a problem? Our fantastic panel of renowned experts is available to answer all your questions related to fashion, well-being, nutrition, finance and hypnotherapy. Email your queries to friday@gulfnews.com.

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