Before Any Surgery, Procedure, or Dental Treatment

Chapter 26 · Vihang Rahul Vasa

Many people living with diabetes will, at some point, need a procedure: a cataract, a dental procedure, a gall bladder, a colonoscopy, an endoscopy, a laparoscopy, a fracture, a CT or MRI scan with dye. Surgery is where diabetes quietly changes the rules, and where most people are never told what to do. My own gall bladder surgery (see Chapter 3) is where I learned most of this: from the experience itself, and from the doctors who looked after me. Every point should be checked with your own surgeon and diabetologist.

Say it first, every time. The first words to any surgeon, anaesthetist, dentist, or radiology staff: “I live with diabetes, and these are my medicines.” Hand over the list from your phone, and your one-page SOAP (Subjective, Objective, Assessment, Plan) report, if you have one (a single sheet with your conditions, medicines, doses, allergies and doctor’s contact, explained in Chapter 14), including insulin and the time you last took each medicine. Do this even for a “small” procedure, even in an emergency, even if you have told them before.

Before the day. For a planned procedure, the surgical team will usually want to see your recent HbA1c (glycated haemoglobin), kidney results, and often a heart check, because, as medical research reports, a person with poorly controlled diabetes can heal more slowly and carries a higher risk of infection and heart trouble around surgery. If your control is poor, the surgeon may ask your diabetologist to improve it before operating. This is not a delay; it is protection. Ask your surgeon and your diabetologist to speak to each other.

Your medicines around surgery: the doctor decides, not you. Some diabetes tablets and some other medicines may need to be paused or adjusted before an operation; insulin doses may change; some medicines must continue. Which ones, and when, is a decision for your treating doctors: never stop or change anything yourself. If nobody has told you what to do with your medicines on the day, ask. Write down the answer.

The fasting trap. “Nothing by mouth from midnight” is a common instruction, though fasting rules differ between hospitals and procedures, and the instruction your treating doctor’s team gives you is the one to follow, and for a person living with diabetes, fasting can bring a low (see Chapter 25). Ask, in advance: “What do I do with my diabetes medicines while fasting? At what time will my procedure be?” In my experience, an early-morning slot is often suggested for people with diabetes so that the fast is short; ask whether that is possible. Check your plasma glucose (blood sugar) on the morning of the procedure and tell the team the number.

After the operation. Pain, stress, and the body’s healing all push plasma glucose (blood sugar) up: expect higher readings for some days, and check more often. Take the wound seriously (Chapter 37): keep it clean, watch for redness, swelling, discharge, or fever, and report any of them the same day. Ask before you leave the hospital: “Who manages my diabetes during recovery, and when do I go back to my normal medicines?” Get the answer in writing.

Dental treatment. The same rules apply in the dentist’s chair: extractions, root canals, implants. Tell the dentist you live with diabetes, share your HbA1c (glycated haemoglobin), and follow the wound advice afterwards (Chapter 37).

CT and MRI scans with dye. Any scan or angiography that uses contrast dye needs your latest kidney results on the table first (see Chapter 33). If you wear a CGM sensor, tell the radiology team, and remove it if your device’s instructions or the team require it (see Chapter 16). Ask.

In an emergency, when there is no time to plan, the one thing that still protects you is the person beside you saying: “He lives with diabetes. Here is his medicine list.” That is why Chapter 28 exists.

(References for this chapter, the care of people with diabetes around surgery and procedures, are listed in Appendix B.)

Illustration: Chapter 26 illustrated summary. Care around surgery, dental treatment and scans includes HbA1c, kidney and heart assessment, a doctor-led medicine and fasting plan, recovery monitoring, wound care, and a medicine list with SOAP summary.

Chapter 26 Care around surgery, dental treatment and scans includes HbA1c (Glycated Haemoglobin), kidney and heart assessment, a doctor-led medicine and fasting plan, recovery monitoring, wound care, and a medicine list with SOAP summary. Follow the CGM device instructions and tell the scan team about the sensor.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.