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Diabetes and Spinal Health

When a diabetic patient goes to surgery they face several challenges which are not present in nondiabetic patients. Diabetic patients have a difficult time maintaining a balance between insulin and its counterregulatory hormones. Surgery and anesthesia usually provoke a neuroendocrine stress response which releases these counterregulatory hormones and cause hyperglycemia and increase catabolism. The larger the surgery, the larger the response. A nondiabetic patient can increase insulin secretion and can maintain glucose balance throughout a surgical procedure. Diabetic patients are unable to compensate and thus oftentimes develop hyperglycemia. Worsening of this elevated blood sugar may result in diabetic ketoacidosis. During brain and spinal surgery, the use of steroids is required.  Steroid usage in the diabetic patient is known to significantly alter blood sugars.

Hyperglycemia can impair wound healing, increase infection, create abnormal bleeding situations and may worsen ischemic brain damage in the elderly. Thus it is important for the preoperative patient to undergo a comprehensive pre-surgical evaluation. Diet, medications and physical activity level should be thoroughly evaluated. Additionally the cardiovascular system should be thoroughly evaluated as diabetic patients frequently have underlying hypercholesterolemia, vascular disease and neuropathy. Renal or kidney function is another common diabetic complication which should be evaluated prior to surgery.
Thus comprehensive preoperative assessment and intensive intraoperative and postoperative management are recommended in order to optimize outcome.

To learn more about Dr. Cotler or to schedule an appointment, please call us on (713) 523-8884 or visit


Howard B. Cotler, MD, FACS, FAAOS is board certified and recertified in Orthopedic Surgery. He is a fellow of the American Academy of Orthopedic Surgery and the American College of Surgeons.

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