Diabetes which complicates surgery

The body fuel is the sugar glucose. For the correct utilization of this, several other sub­stances are needed in the body. One of the most vital of these is the hormone insulin, which is manufactured in the pancreas, a gland within the abdomen. When insulin is not manufactured in sufficient amounts, glu­cose utilization is disturbed, and the disease called diabetes mellitus (sugar diabetes) ex­ists. Since the cause and control of this disease have been discovered, diabetic patients can lead a full normal life, with the proper care. It is greatly advantageous to the diabetic to know all the sound facts that he can about his dis­ease, and to this purpose numerous excellent books and articles have been made available for the laity. The person who is a known diabetic is referred to these.

The control of diabetes rests with replacement therapy, that is, supplying to the body the sub­stance insulin which it is unable to manufacture in sufficient amounts for itself. Also of impor­tance is the accurate control of the amount of sugar foods (carbohydrates) which is taken into the body. There must be an accurate balance between the amount of carbohydrates and the amount of insulin. The consequences of not maintaining such balance from hour to hour are many and indeed serious. States of coma result from insufficient or from oversupply of insulin, and the margin of safety is narrow. Prolonged slight imbalance leads to other chronic disease conditions.

Diabetic persons are especially prone to de­velop certain other disease states; namely, heart disease, infections, and hardening of the arter­ies. Proper diabetic care includes careful pre­ventive measures against these. Of greatest con­cern in the field of surgery are the infections. Not only are all types of infections more likely to occur in the diabetic than in the normal in­dividual, but they are also more difficult to control due to the disturbed tissue metabolism in the use of fuel. And when infections occur, the balance between the glucose supply and in­sulin is often upset.

Before the introduction of insulin for the control of the disease, diabetes was a common cause of death. But today, most diabetics live on to succumb from other causes, some of which are associated complications and many of which are surgical in nature. The life span of the gen­eral population is increasing, and concomitantly the incidence of diabetes increases. More and more diabetic persons enter the age groups in which surgical states occur more frequently, and consequently a greater number of these be­come surgical patients as well as medical.

The diabetic surgical patient requires close association of the concurrent treatment of the medical and the surgical conditions. This meta­bolic medical disease must especially be per­fectly controlled during the time of surgical therapy. If operation is necessary, particular and specialized preparation and after-care must be afforded. Often a medical specialist and the sur­geon co-ordinate their skills in the care of the diabetic surgical patient, working in closely as­sociated consultation throughout the surgical course. It is only such unremitting care that is responsible for the fact that concomitant dia­betes does not appreciably raise the risk of sur­gical intervention or the incidence of surgical morbidity.