Question

You have just returned from a 2-day workshop on guidelines for the care of surgical patients with type 1 D M. You notice that E.B.'s daily fasting blood glucose has been running between 130 and 180 mg/dL. The sliding scale insulin intervention does not begin until blood glucose values equal to or greater than 200 mg/dL are reported. You recognize that patients with blood glucose values even slightly above normal levels experience impaired wound healing. However, you also recognize that the risks related to hypoglycemia, such as falls, might outweigh the risk of impaired healing from elevated glucose levels.

What is causing E.B.'s pain?

Answer 1

Diabetes Mellitus

Diabetes is a group of metabolic diseases where by a person has high blood sugar due to an inability to produce or inability to metabolize , sufficient quantities of the hormone insulin.

Type 1 Diabetes Mellitus is also known as Insulin dependent diabetes . This chronic condition is characterised by the insufficient production of Insulin from pancreas. Hormone insulin is essential for the uptake of glucose by cells.  

Causes of EB's pain

* Surgery and anaesthesia may cause increase in blood glucose level due to the production of stress hormones ( As stress hormones may make cells to be more resistant to insulin), even in the normal people .

* Stress of surgery may increase the production of cortisol . Cortisol stimulates the glucose production from liver and it increases the blood glucose level.

*Hyperglycemia can cause impaired wound healing. High blood sugar can decrease the blood flow and nerve damage. Poor circulation and decreased nutrient supply to wound may slow the process of wound healing and there by causes pain and infection of the surgical incision.

High blood sugar level in postoperative period may increase the risk of poor wound healing, pain ,infection, increased hospital stay, mortality among patients. Slow healing anc pain may affect the quality of life of the patient.

How to manage without insulin intervention:

* Eat healthy food and low calorie food a such as whole grains, fruits ( vitamin c) , vegetables and lean meat for protein.

* Wound care: aseptic conditions , proper dresing and care of the wound and strict observation for signs of infection

* Dry the area well before covering .

* Apply the oinments or administer medications as per physician's order.