Diabetes and Spine Surgery: What You Need to Know

If you have diabetes and will undergo spine surgery, you need to make special accommodations to ensure a successful surgery and recovery. People with diabetes are at a higher risk for certain issues, such as infection and slower healing. Fortunately, you can take steps before and after spine surgery to reduce the potential for these complications.

Diabetes and Spine Surgery: Why an Increased Risk of Complications?
Neck or back surgery can cause physical and mental stress that leads to changes in your body’s hormone levels. These changes can cause increased insulin resistance, a condition in which the body produces insulin—a hormone that regulates the amount of sugar (glucose) in the blood—but does not use it effectively.

Hormone fluctuations can also cause the body to produce less insulin and lead to other changes that increase the risk of hyperglycemia, or high blood sugar. High (or low) blood sugar levels increase the risk and severity of complications after surgery.

If you have diabetes, the risk of complications after surgery is greater if you have had diabetes for a long time, frequently have high blood sugar levels, or if you have trouble controlling your levels. That’s why it’s important to work with your diabetes care team to develop strategies to manage your blood sugar before you undergo spine surgery.

Medication Considerations for People with Diabetes
Talk with your healthcare provider about what steps you should take to control your diabetes before spine surgery. In some cases, this will involve changes to your diabetes medication. Be sure that these steps are communicated to the surgeon.

It may be helpful to see a certified diabetes educator (CDE). Medicare covers two hours of diabetes self-management education (DSME) per year, with your healthcare provider’s referral. Most insurance will cover DSME as well. By seeing a CDE, you can obtain an individualized plan for your care before, during and after surgery.

If you take type 2 diabetes medications to control blood sugar, ask your doctor about adjustments you should make (if any) to your regular dosage.

If you have type 1 diabetes and take insulin, talk with your healthcare provider about what dose you should take the night before and the day of surgery.

Questions to Ask Before Your Spine Procedure

1. Who will manage my diabetes during my outpatient spine surgery or hospital stay? The surgeon, my endocrinologist, my family practitioner or hospitalist?
2. Who will manage my diabetes during the surgery? (Unless your procedure is very quick, your anesthesiologist can provide insulin or glucose to keep your blood sugar level within the acceptable range.)
3. What should I do if I have low or high blood glucose the morning of surgery?
4. When should I have my last meal/fluid before surgery?

Lifestyle Changes to Consider Before Surgery
Diet: A nutritious meal plan with plenty of protein helps the healing process and can contribute to stronger tissue at the surgical site. It is important not to skip meals in order to get the calories and protein you need to heal.

Exercise: If you are not already exercising regularly, talk with your doctor about starting before you undergo surgery. Exercise will strengthen your body and may help you recover quicker.

Alcohol and smoking: Quitting or reducing alcohol before surgery will help you control your blood sugar. Quitting smoking will make it easier to breathe after surgery.

Stress reduction: Stress can elevate your blood glucose levels, so try to stay as relaxed as you can about your upcoming procedure. You may find it helpful to talk with others about your concerns or try relaxation techniques, such as slow and deep breathing. Listening to music or exercising may also help.

Diabetes-specific Risks After Spine Surgery
Though optimal blood sugar control and healthy lifestyle habits will improve your surgery recovery outlook, you may still experience these diabetes-specific complications after back or neck surgery:

• High or low blood sugar levels—talk to your healthcare provider to have a plan on how to increase or reduce your medications to help your blood sugar control
• Poor, slow wound healing
• Weak skin and tissue at the surgical site
• Infection of the wound (see below for additional information on signs of infection)
• Pneumonia, urinary tract infection, or sepsis (blood infection)
• Diabetic ketoacidosis (a condition in which toxic acid byproducts called ketones build-up in the blood and can become life-threatening)
• Electrolyte imbalance (this occurs when sodium and potassium levels increase or drop significantly, which can cause serious problems with the heart and the body’s fluid levels)

Taking Care of Yourself Once You Come Home
Once you return home, check your blood glucose levels often. You may have more trouble controlling your levels after surgery if you aren’t eating regularly, are vomiting, feel stress, or are less active than usual.

Watch for the following signs of infection, and call your doctor if you experience any of the following:

• Fever greater than 101 degrees
• Incision site that is red, hot to the touch, or oozing
• Pus or foul drainage
• Pain around the incision site that continues to worsen
• Swelling or hardening of the incision site

Also, keep an eye out for potential bedsores. To prevent bedsores, move around in bed, and get out of bed often. If you can’t feel your toes or fingers as well as you normally could, you may not feel a bedsore developing.

Undergoing back or neck surgery is stressful on its own, but adding diabetes to the mix adds a whole other level of complications. But having a clear plan to help keep your stress levels and blood sugar under control can help ensure a successful spine procedure.

SOURCE: https://www.spineuniverse.com/treatments/surgery/diabetes-spine-surgery-what-you-need-know