I am 5O years old. I have been diagnosed with Type 2 Diabetes for S years now.Why is blood sugar control necessary before eledive surgery?In general, people with Diabetes undergo certain procedures and surgeries more commonly than people without Diabetes. They often require a frequent and longer duration of hospitalisation and more cost to manage than people without Diabetes.Preoperative hyperglycaemia (high blood sugar levels before a surgery) increases the risk of death by a heart attack, impairment of the nervous system, secondary infection and other post-surgery complications. More than one-third of people who are scheduled for any surgery remain unrecognised of their Diabetes status..Hence, diagnosis of Diabetes before surgery is necessary. Haemoglobin A1c (HbAlc) is a suitable screening test to diagnose people whether have Diabetes, before surgery.Surgical procedures may result in several metabolic changes that can alter the way the body processes glucose..This results in high blood sugar levels in the body which is a risk factor for post-surgery infection in the blood, endothelial (the lining in the blood vessels) dysfunction, stroke caused by insufficient oxygen supply to the brain, impaired wound healing and delayed recovery.Complications from surgical wounds are more common in people with Diabetes and healing is impaired when blood sugar levels are not managed well.In addition to this, surgery-related stress results in increased production of stress hormones like cortisol and catecholamine which reduce insulin sensitivity and lead to diabetic ketoacidosis or coma. Screening for Diabetes-related complications like neuropathy, nephropathy, retinopathy and heart disease is necessary to stabilise a person with Diabetes before any surgical procedure. If any complication arises due to high blood sugar levels then the surgery should be postponed to a later date.If a person is taking oral Diabetes medication then it has to be stopped before the planned surgical procedure. The target blood sugar level at the time of surgery should be 80-180 mg/dL. Insulin is the best choice for most people who are scheduled to undergo any surgical procedure. Thebest choices are rapid and long-acting insulin in the form of continuous intravenous infusion or basal-bolus regimen.Dr Gourish KarandeConsultant Physician .I am a 55-year-old male. I take medication for high blood pressure. My doctor has advised me of home monitoring of blood pressure. Why is ambulatory blood pressure monitoring important?The normal blood pressure range is 120/80 mm Hg. Hypertension is a blood pressure measurement when the systolic (upper) blood pressure is at or above 140 mm Hg and the diastolic (lower) blood pressure is at or above 90 mm Hg. Usually, only one or two readings are taken during a doctor's visit with an instrument called a sphygmomanometer. However, in ambulatory BP monitoring, readings are taken every 20 to 30 minutes during the day and night. So it is continuous monitoring of blood pressure over 24 hours, whether the person is awake or asleep. It consists of a small digital blood pressure recording machine and a Velcro cuff. The machine is attached to a belt and is worn around the body and while the cuff is wrapped around the upper arm.Abnormal fluctuations in blood pressure might occur due to daily activities, sleep and in conditions like white coat hypertension, masked hypertension, and sustained hypertension. When only one or two readings are taken during a doctor's visit such fluctuations might not be detected. Some people have elevated blood pressure readings when taken at a doctor's clinic is known as white coat hypertension. This can result in misdiagnosis of hypertension whose blood pressure is otherwise normal. In masked hypertension,a person's blood pressure reading is normal at the doctor's office but is elevated when he or she is at home. Sustained hypertension refers to BP readings that are elevated whether the patient is in the doctor's clinic or at home. All these scenarios may lead to a misdiagnosis which may cause further complications, especially in Diabetes.Some of the advantages of ambulatory blood pressure monitoring are:• It helps correlate changes in blood pressure with daily activities and to detect nocturnal hypertension or loss of blunted or abolished overnight dips in blood pressure.• It prevents misdiagnosis of white coat hypertension.• It helps detect masked hypertension so that the incidence of stroke, heart disease and organ damage due to high blood pressure can be reduced.• It helps evaluate a person's response to long-acting antihypertensive medications.Dr Ashutosh PakaleConsultant Physician
I am 5O years old. I have been diagnosed with Type 2 Diabetes for S years now.Why is blood sugar control necessary before eledive surgery?In general, people with Diabetes undergo certain procedures and surgeries more commonly than people without Diabetes. They often require a frequent and longer duration of hospitalisation and more cost to manage than people without Diabetes.Preoperative hyperglycaemia (high blood sugar levels before a surgery) increases the risk of death by a heart attack, impairment of the nervous system, secondary infection and other post-surgery complications. More than one-third of people who are scheduled for any surgery remain unrecognised of their Diabetes status..Hence, diagnosis of Diabetes before surgery is necessary. Haemoglobin A1c (HbAlc) is a suitable screening test to diagnose people whether have Diabetes, before surgery.Surgical procedures may result in several metabolic changes that can alter the way the body processes glucose..This results in high blood sugar levels in the body which is a risk factor for post-surgery infection in the blood, endothelial (the lining in the blood vessels) dysfunction, stroke caused by insufficient oxygen supply to the brain, impaired wound healing and delayed recovery.Complications from surgical wounds are more common in people with Diabetes and healing is impaired when blood sugar levels are not managed well.In addition to this, surgery-related stress results in increased production of stress hormones like cortisol and catecholamine which reduce insulin sensitivity and lead to diabetic ketoacidosis or coma. Screening for Diabetes-related complications like neuropathy, nephropathy, retinopathy and heart disease is necessary to stabilise a person with Diabetes before any surgical procedure. If any complication arises due to high blood sugar levels then the surgery should be postponed to a later date.If a person is taking oral Diabetes medication then it has to be stopped before the planned surgical procedure. The target blood sugar level at the time of surgery should be 80-180 mg/dL. Insulin is the best choice for most people who are scheduled to undergo any surgical procedure. Thebest choices are rapid and long-acting insulin in the form of continuous intravenous infusion or basal-bolus regimen.Dr Gourish KarandeConsultant Physician .I am a 55-year-old male. I take medication for high blood pressure. My doctor has advised me of home monitoring of blood pressure. Why is ambulatory blood pressure monitoring important?The normal blood pressure range is 120/80 mm Hg. Hypertension is a blood pressure measurement when the systolic (upper) blood pressure is at or above 140 mm Hg and the diastolic (lower) blood pressure is at or above 90 mm Hg. Usually, only one or two readings are taken during a doctor's visit with an instrument called a sphygmomanometer. However, in ambulatory BP monitoring, readings are taken every 20 to 30 minutes during the day and night. So it is continuous monitoring of blood pressure over 24 hours, whether the person is awake or asleep. It consists of a small digital blood pressure recording machine and a Velcro cuff. The machine is attached to a belt and is worn around the body and while the cuff is wrapped around the upper arm.Abnormal fluctuations in blood pressure might occur due to daily activities, sleep and in conditions like white coat hypertension, masked hypertension, and sustained hypertension. When only one or two readings are taken during a doctor's visit such fluctuations might not be detected. Some people have elevated blood pressure readings when taken at a doctor's clinic is known as white coat hypertension. This can result in misdiagnosis of hypertension whose blood pressure is otherwise normal. In masked hypertension,a person's blood pressure reading is normal at the doctor's office but is elevated when he or she is at home. Sustained hypertension refers to BP readings that are elevated whether the patient is in the doctor's clinic or at home. All these scenarios may lead to a misdiagnosis which may cause further complications, especially in Diabetes.Some of the advantages of ambulatory blood pressure monitoring are:• It helps correlate changes in blood pressure with daily activities and to detect nocturnal hypertension or loss of blunted or abolished overnight dips in blood pressure.• It prevents misdiagnosis of white coat hypertension.• It helps detect masked hypertension so that the incidence of stroke, heart disease and organ damage due to high blood pressure can be reduced.• It helps evaluate a person's response to long-acting antihypertensive medications.Dr Ashutosh PakaleConsultant Physician