Surgery
Surgery is stressful, both physically and
mentally. It can raise blood glucose levels even in someone who is
careful about control.
| Points to Remember
- Special situations such as pregnancy, surgery, and
illness call for extra careful diabetes control.
- Special control may require the use of
insulin, even in people who don't normally use
insulin.
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To make sure that surgery
and recovery are successful for someone with diabetes, a doctor will
test blood glucose and keep it under careful control, usually with
insulin. Careful control makes it possible for someone with diabetes
to have surgery with little or no more risk than someone without
diabetes.
To plan a safe and successful surgery, the surgeon and
attending physicians must know that the person they're
treating has diabetes. While tests done before surgery can
detect diabetes, the patient should inform the doctor of his
or her condition. A surgical team also will evaluate the
possible effect of complications of diabetes, such as heart
or kidney problems.
Pregnancy
Bearing a child places extra demands on
a woman's body. Diabetes makes it more difficult for her
body to adjust to these demands and it can cause problems
for both mother and baby. Some woman may develop a form of
diabetes during pregnancy called gestational diabetes.
Gestational diabetes develops most frequently in the middle
and later months of pregnancy, after the time of greatest
risk for birth defects. Although this kind of diabetes often
disappears after the baby's birth, treatment is necessary
during pregnancy to make sure the diabetes doesn't harm the
mother or fetus.
A woman who knows she has diabetes should keep her
condition under control before she becomes pregnant, so that
her diabetes won't increase the risk of birth defects. A
woman whose diabetes isn't well controlled may have an
unusually large baby. Diabetes also increases the risk of
premature birth and problems in the baby, such as breathing
difficulties, low blood sugar and occasionally, death.
Blood glucose monitoring and treatment with insulin can
ensure that a baby born to a mother with diabetes will be
healthy. Oral diabetes drugs aren't given during pregnancy
because the effects of these drugs on the unborn baby aren't
known. By following the advice of a doctor trained to treat
gestational diabetes, the mother can make sure her blood
glucose is normal and her baby is well nourished.
Approximately half of women with gestational diabetes
will no longer have abnormal blood glucose tests shortly
after giving birth. However, many women with gestational
diabetes will develop noninsulin-dependent diabetes later in
their lives. Regular check-ups can ensure that if a woman
does develop diabetes later, it will be diagnosed and
treated early.
Is Diabetes Hereditary?
Scientists estimate that the child of a parent with
noninsulin-dependent diabetes has approximately a 10 to 15
percent chance of developing noninsulin-dependent diabetes.
If both parents have diabetes, the child's risk of having
the disease increases. The child's health habits throughout
his or her life will affect the risk of developing diabetes.
Obesity, for example, may increase the risk of diabetes or
cause it to occur earlier in life.
Noninsulin-dependent diabetes in a parent has no effect
on the chances that his or her child will have
insulin-dependent diabetes, the more severe form of
diabetes.
Drinking fluids during illness is especially
important for someone with diabetes.
Stress and Illness
One way the body responds to stress is
to increase the level of blood glucose. In a person with
diabetes, stress may increase the need for treatment to
lower blood glucose levels. Illnesses such as colds and flu
are forms of physical stress that a doctor can treat. The
doctor will advise the person to drink plenty of fluids.
When blood glucose is high, the body gets rid of glucose
through urine, and this fluid needs to be replaced.
If nausea makes eating or taking oral diabetes drugs a
problem, a doctor should be consulted. Not eating can
increase the risk of low blood glucose, while stopping oral
medications or insulin during illness can lead to very high
blood glucose. A doctor may prescribe insulin temporarily
for someone with diabetes who can't take medicine by mouth.
Great thirst, rapid weight loss, high fever, or very high
urine or blood glucose are signs that blood sugar is out of
control. If a person has these symptoms, a doctor should be
called immediately.
Like illness, stress that results from losses or
conflicts at home or on the job can affect diabetes control.
Urine and blood glucose checks can be clues to the effects
of stress. If someone finds that stress is making diabetes
control difficult, a doctor can advise treatment and suggest
sources of help.
Alcoholic Beverages
Most people with diabetes can drink alcohol safely if they drink
in moderation (one or two drinks occasionally), because in
higher quantities alcohol can cause health problems:
- Alcohol has calories without the vitamins,
minerals, and other nutrients that are essential for maintaining
good health. A doctor can discuss whether it's safe for an
individual with diabetes to drink. People who are trying to lose
weight need to account for the calories in alcohol in diet
planning. A dietitian also can provide information about the
sugar and alcohol content of various alcoholic drinks.
- Alcohol on an empty stomach can cause low blood glucose or
hypoglycemia. Hypoglycemia is a particular risk in people who
use oral medications or insulin for diabetes. It can cause
shaking, dizziness, and collapse. People who don't know someone
has diabetes may mistake these symptoms for drunkenness and
neglect to seek medical help.
- Oral diabetes medications--tolbutamide and chlorpropamide--can cause dizziness, flushing, and nausea when
combined with alcohol. A doctor can advise patients on the
safety of drinking when taking these and other diabetes
medications.
- Frequent, heavy drinking can cause liver damage over time.
Because the liver stores and releases glucose, blood glucose
levels may be more difficult to control in a person with liver
damage from alcohol.
- Frequent heavy drinking also can raise the levels of fats in
blood, increasing the risk of heart disease.