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?
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 (see Questions 32, 33, and 34 for detailed discussion of these) 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.
My child has diabetes and is about to start school. What steps should I take and how will the school help to ensure that things go well?
Nowadays, diabetes alone seldom prevents children from attending and participating fully in school activities, although special attention is required in certain circumstances. Fortunately, most children at the age of school entry have, by virtue of their age, not had diabetes for very long. Therefore, they rarely have chronic complications and their glucose control is more straightforward. The American Diabetes Association and other authoritative bodies recommend less stringent control of blood sugar in young children in order to avoid hypoglycemia, which is the overriding concern.
In general, it is important to remember that each person, young or old, experiences diabetes differently. This is challenging and humbling for those of us who see people with diabetes every day. For your child's teachers, whose primary role is education unrelated to diabetes, it can be a major challenge indeed. Therefore, preparation is the key. It is important to provide the school with a daily plan describing the way your child's diabetes is managed, so they know what to expect as routine. It is important to inform the school how things may present themselves when they go wrong. How does your child's diabetes respond when he or she is under the weather, under stress, or following strenuous sports activities? What behavior does he or she show when low blood sugar occurs? All these things should be written down and put in a folder for your child's school nurse and teacher. A meeting with the teacher prior to your child entering their class will help to smooth the way. There is also a document, known as a 504 plan, which is used to describe the expectations and roles of the parents and the school in the management of the diabetes and when things go wrong. Further details are beyond the scope of this book, but excellent sources of information, including sample 504 plans, can be found at various websites including those of the Juvenile Diabetes Research Foundation (go to kids.jdrf.org/index.cfm and click on Your Life With Diabetes and then select To School), American Diabetes Association (diabetes.org/for-parents- and kids/for-schools/diabetes-management.jsp), and the National Institutes of Health (ndep.nih.gov/ diabetes/youth/youth.htm).