I have heard that wounds heal more slowly in people with diabetes. Is this true and should I be worried when I go in for an operation?
Answer:
In patients whose diabetes is under good control and who do not have complications from it, wound healing is generally fairly normal, especially in younger people. On the other hand, when diabetes is poorly controlled and when it is accompanied by chronic complications, wound healing can be significantly impaired. The longterm complications of diabetes occur due to damage to the very small blood vessels nourishing the tissues and organs of the body. The skin is one of these organs and, although skin disorders due to diabetes are not common, they can and do occur. The body's ability to heal a wound depends upon a healthy blood supply, which is needed to deliver nutrients, on the cells that provide the protective defense against infection and those that cause inflammation. In this sense, inflammation is beneficial in that it leads to the mopping up and removal of dead and damaged tissue, which paves the way for its replacement by new healthy healing skin and underlying tissue. Second, short-term high blood sugar paralyzes these blood and tissue defenses, so that their infection-fighting and inflammatory actions are much weaker. Finally, insulin itself stimulates healing and regenerative actions in body tissues. If the diabetes is poorly controlled, this suggests that insulin is insufficient or ineffective, which can further impair healing. For these reasons, your doctor will try to help you get your diabetes under the best possible control before you go in for a nonemergency operation. If you have chronic complications of your diabetes, special attention should be paid to measures that will help your surgical wound to heal, such as ensuring adequate blood supply by keeping the area warm and not placing excessive pressure on it, and meticulous attention to the avoidance of infection. Your blood glucose will also be carefully controlled during the period immediately following surgery, with insulin if necessary.
