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Cosmetic surgery diabetes



Hi, this is Dr. Hourglass, and welcome to another video in our channel Superhourglass. Today we are going to discuss the implications of diabetes for cosmetic surgery. In this channel, we will discuss everything you need to know for you to get the hourglass shape you’ve always wanted.

Diabetes is a common condition among the United States population. There are actually two types of diabetes: type 1, where patients require insulin, and type 2, which can be controlled with diet as well as oral medication. The metabolic impact of surgery, fasting, and interruption of glucose therapy contributes to poor glucose control, which in turn can significantly increase mortality, morbidity, and length of stay in patients with diabetes. Patients with diabetes have a higher incidence of complications after surgery, so the reason for maintenance of blood sugar during the surgery is to decrease the adverse outcomes related to this condition. High blood sugar or hyperglycemia is associated with an increase of adverse outcomes in hospitalized patients with both medical and surgical conditions, whether the patient is known to have diabetes or not. There is a strong correlation, and studies have shown that having high blood sugar during the surgical procedure increases complications following surgery, including infection. Blood sugar control during the first day after surgery helps prevent infection. In addition, diabetic patients are more prone to what is called nosocomial infections, which are infections that are actually acquired while you are at the hospital. Treatment of postoperative high blood sugar reduces the risk of adverse outcomes. Prevention of high blood sugar also reduces the risks of postoperative complications from any surgery.

While modern anesthetic and surgical techniques have reduced the metabolic impact of surgery, because surgery creates stress during the procedure, including increasing the hormones of the body as well as the overall metabolic impact on the body, studies have shown and we can infer that any patient with diabetes needs to have their blood sugar well controlled; this includes cosmetic surgery patients. The distinction between type 1 and type 2 diabetes can be very difficult, especially if somebody has been a type 2 diabetic for a long time. Type 1 diabetics are prone to develop what we call diabetic ketosis or ketoacidosis within hours if insulin is withdrawn or omitted, especially at times of physiological stress such as surgery when counter-regulatory hormone production is increased. Type 2 diabetics may also develop diabetic ketoacidosis with sufficient physiological stress and sufficient insulin deficiency; such patients usually have been diabetic for more than ten years. In other words, the more insulin deficient the patient is, the greater the metabolic impact of surgery. This is the reason that postoperative high blood sugar should be anticipated and prevented in such patients when they undergo a major surgery.

Another surgical implication is that diabetics, like any other patient, need to fast before surgery. If a patient has what is called diabetic gastroparesis, it may result in delaying gastric emptying and subsequently aspiration after surgery, pneumonia, and death. In addition, gastroparesis may result in persistent nausea or vomiting with consequences such as delaying resumption of oral intake. There is no question that surgery may also precipitate heart ischemia or attack. One of the things we all need to look out for is that a patient with diabetes can actually have a silent heart attack, where there are absolutely no physical symptoms,.

If you have diabetes, it is not a contraindication of having cosmetic surgery. It will all depend on your preoperative levels, including HCB 1, as well as other factors that your surgeon needs to take into consideration before surgery. You need to have your glucose very well controlled. As a matter of fact, if you are overweight, you might be one of the 20% of diabetics who do not even know it. This is the reason that I always check the glucose in patients who are at high risk of having diabetes before any cosmetic surgery. You might be diabetic and not know it. If you have diabetes that is not controlled, your cosmetic surgery needs to be delayed. Cosmetic surgery is not a necessary procedure, so it is important to delay until blood sugar is controlled.

In addition, if you are diabetic, it is extremely important that you be the first patient who has surgery during the day, because fasting can create de-arrangement in the metabolism of glucose itself. This can actually help control and prevent postoperative complications. It is paramount that a surgeon who understands your condition do your procedure. The surgery may be successful, but if preventive measures are not implemented, you can develop complications like wounds during your stay at the surgical facility or infections after the surgery itself.

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