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Surgery with diabetes

J

JamesyFFC

New Member
Relationship to Diabetes
Type 3c
Hi guys,

Recently posted on another thread about my diabetes which resulted in a major loss of mobility after a 6 month hospital stay with necrotising pancreatitis.

After 7 years of not giving up, I am finally up for surgery to essentially get my left foot rebuilt and get me off the crutches! Surgery will be a rebuild of the ACL etc to fix the drop foot and position, giving me a base to learn to walk "normally" again.

Anyway! Usual nerves, got the pre op coming up. My control is normally pretty good, 80%+. After an admittedly heavy Christmas etc this has dropped to just being above 70% in range.

Just looking for anyone who has experience of surgery with diabetes. The HbA1C range, recovery, advice. Anything really!

Appreciate it!
 
I have had (non diabetic-related) surgery recently.
They had no interest in my time in range. They were interested in my HBA1c and took my BG before surgery.

I do not know the acceptable range, only that 45 was an acceptable HBA1c.

After surgery, my BG was raised and I needed 50% extra insulin for about 2 weeks to keep me range as my body repaired. I use a pump so increasing insulin is easier than MDI (I can adjust my basal by the hour rather than daily).

My recovery from the surgery was no longer than someone without diabetes.

They requested I was nil by mouth for 5 or 6 hours before the surgery. This had concerned me with regard to what do I do if I have a hypo in that time. Thankfully, I didn't but I asked at the hospital. They said, if it happened while I was there, they would give me a glucose drip but not to worry if I needed to eat something quickly.
In reality, the stress of the upcoming surgery was keeping my BG raised.
 
Hi. What sort of HbA1c is Libre predicting? I know the Libre predictions are not generally very accurate but they will give you a ball park figure. Mine usually predicts about 3-5mmols lower than my actual blood result.
The hospital will usually have a cut off HbA1c level for surgery to reduce the risk of infection and improve outcomes and it might vary depending upon the type of surgery. With it being your foot, which can be more prone to infection than more central parts of the body with better blood flow, they may have a tighter limit. It sounds like your TIR is good though so I would be surprised if you don't manage to be below the level they require. What was your last HbA1c result?

Excuse my curiosity, but Is the surgery for Charcot Foot? Hope it all goes smoothly for you and enables you to get better mobility, especially after such a long wait. I imagine you must be anxious about it.
 
Thanks everyone, pretty much as I expected!

Can't actually remember my last HbA1c but the surgeon was happy with it end of November so wont expect any drastic changes.

Haven't heard the term Charcot foot, I had severe drop foot in ICU, right foot recovered enough, left foot I had 0 dorsi flexion. Some lateral movement, but the tendons have shortened and tightened so much they are holding the foot in the wrong position. There are no guarantees but this at least gives me a base to start again! As 7 years of walking essentially on the outside of my left foot has taken its toll!
 
Charcot foot is a rare complication of diabetes, where the bone structure of the foot starts to break down and the foot becomes deformed and inflamed. It is sometimes misdiagnosed, as not many medics know much about it. If you had very high BG levels when this problem developed, I would guess it may be a possibility. @Flower is our resident expert on Charcot Foot.
 
Hi @JamesyFFC

I’ve had a number of orthopaedic operations on my feet & ankles. Taking control of your diabetes as soon as you’re able to after surgery has been the best option for me to get back to normal.

Pain following surgery can cause elevated blood glucose so try to keep your pain levels controlled as best you can.

If you are going to be in a cast or air boot after surgery be vigilant of how your foot feels and look out for any abrasions or blisters in the skin on your foot. If you’re in a boot you can check yourself but if in a cast and something doesn’t feel right then do contact your clinic & ask for a new cast. If your foot is being repositioned you might be putting pressure through new areas of your foot.

If non weight bearing for a time I find that drops my glucose fast as it’s strenuous exercise hopping on one leg. Have some hypo remedies to hand!

I hope all goes well for you & your diabetes behaves itself. Best wishes.
 
Flower said:
Hi @JamesyFFC

I’ve had a number of orthopaedic operations on my feet & ankles. Taking control of your diabetes as soon as you’re able to after surgery has been the best option for me to get back to normal.

Pain following surgery can cause elevated blood glucose so try to keep your pain levels controlled as best you can.

If you are going to be in a cast or air boot after surgery be vigilant of how your foot feels and look out for any abrasions or blisters in the skin on your foot. If you’re in a boot you can check yourself but if in a cast and something doesn’t feel right then do contact your clinic & ask for a new cast. If your foot is being repositioned you might be putting pressure through new areas of your foot.

If non weight bearing for a time I find that drops my glucose fast as it’s strenuous exercise hopping on one leg. Have some hypo remedies to hand!

I hope all goes well for you & your diabetes behaves itself. Best wishes.
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Hi Flower,

Really appreciate that response. The plan is of course to get right back on track of controlling it after surgery, sometimes hard when feeling a bit sorry for yourself as everyone will know!

That is my main concern, it'll be a cast and non weight bearing for several weeks so risk of infection is a worry especially with a wound under the cast. Will just be vigilant and keep an eye on things.

Sorry if it appears rude, but how successful have your orthopaedic surgeries been? I have a great surgeon who is pretty confident of getting me off the crutches but I am naturally dubious after years of struggling to be honest.

Thanks again
 
When in a cast the best you can do is be very vigilant & aware of how your foot feels. Watch out for excessive swelling beyond post surgery swelling, any new soreness, skin redness, high blood glucose from potential infection of the wound & any discharge/smell from the cast- I really hope you don’t get that.

My surgeries were limb salvage due to the bones & joints in my foot collapsing and displacing due to Charcot foot - a neuropathic complication of diabetes. It was either surgery to try & attach my foot to my leg with metal after my ankle joint crumbled or amputation. It didn’t work completely as my leg is in a cast ongoing as new bone hasn’t grown around the metal & I can’t walk without crutches. I suppose it was successful in that I still have two legs but it was never going to result in a normal foot.

Yours sounds for a different reason & will hopefully result in a foot you can position & walk on after surgery & rehabilition/physio. I hope all goes well & you can get off crutches.
 
Thanks Flower, what a torrid time you have had of it and appreciate you sharing. Keep doing what you are doing!
 
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