Introduction
The severity of hypoglycemia (a condition where the blood glucose levels are lower than normal) following weight-loss surgery and even other gastrointestinal procedures may be reduced with the continuous monitoring of glucose levels. Hypoglycemia is a potential complication following many gastrointestinal surgeries. Studies show that about thirty percent of people have faced hypoglycemia following various types of gastrointestinal surgical procedures.
What Is Continuous Glucose Monitoring?
A continuous glucose monitor (CGM) is a gadget that automatically measures the blood sugar level. The device must be fastened to the body in some way; it could be implanted or wearable. A continuous glucose meter (CGM) can be positioned in the subcutaneous area to measure the glucose levels in the interstitial fluid (ISF) or in a blood vessel to evaluate the glucose levels in the blood. Intravascular sensors are not common and carry a risk of thrombosis and bleeding. Calibration or checking of subcutaneous glucose sensors may be necessary as little as once a day or as frequently as four times.
What Are the Advantages of Continuous Glucose Monitoring?
As nurses do not need to check blood glucose levels as frequently, one benefit of automatic glucose measurements is the time savings. Factory adjustments are the next one. The manufacturer pre-determined them, and they are not set at each use time. In addition, it is considered nearly as accurate as the majority of blood glucose monitors.
Who Needs to Have Their Glucose Levels Checked?
An anesthesiologist managing patients with or without diabetes needs access to a complete glycemic profile during the operative period. But until quite recently, there has been inconsistent accuracy and performance data from automatic continuous glucose monitors used during surgery. Significant glucose variability is observed when patients with gastric bypass undergo continuous glucose monitoring (CGM). In addition, there can be notable hyperglycemic (elevated blood sugar levels) spikes, regardless of the presence or absence of hypoglycemia. glucose variability (GV) is the maximum or minimum index of glucose levels in 24 hours.
The use of continuous glucose monitoring following bariatric surgery has also proven beneficial in confirming the existence of hypoglycemia in patients both with and without neuroglycopenia symptoms. Neuroglycopenia is a condition where the central nervous system is affected due to the insufficient supply of glucose. Positive outcomes have been observed in two studies that evaluated the impact of short-term interventions (acarbose or carbohydrate consumption reduction) on GV and hypoglycemic symptoms in patients with a gastric bypass. The ability to measure precise glucose patterns has prompted the identification and treatment of both GV and hypoglycemia as contributing factors to metabolic and weight control. Due to their potential to affect weight, eating habits, quality of life, and cardiovascular outcomes, these phenomena are unlikely to be picked up by traditional follow-up and must be treated.
How Is a Diabetic Patient Managed?
In practical terms, intensive perioperative diabetes management is deemed appropriate for all patients with type 1 diabetes undergoing any big or small gastrointestinal surgery, as well as all patients with type 2 diabetes undergoing major gastrointestinal surgery. Insulin therapy is always used with dextrose and potassium infusion as part of the management strategy for these patients.
-
Patients Who Are Controlled With Diet: Individuals with diabetes who maintain reasonable control over their condition through diet and exercise regimens might not need any special preoperative care. Measuring fasting blood glucose on the morning of the surgical procedure is recommended. If the procedure will take longer than an hour, blood glucose monitoring between the procedures can be considered.
-
Patients on Oral Antidiabetic Medication: All second-generation Sulfonylureas should be stopped one day before surgery, except for Chlorpropamide, which must be stopped two or three days earlier. Additional medications can be used until the day of the surgical procedure. Even though the half-life of metformin is only about 6 hours, it is advisable to stop treatment one to two days before the surgery temporarily. It is advisable to check the blood glucose levels in all patients before and right after surgery. People having major surgery should check their blood sugar every hour during and after the procedure. Before taking steps to rectify the problem, though, abnormally high or low values should be rechecked immediately, and a blood sample should be sent for laboratory confirmation simultaneously.
-
Patients Who Take Insulin: It is recommended that patients receiving long-acting insulin (which might include Ultralente, Glargine, or Protamine zinc insulin) switch to intermediate-acting forms one to two days before elective surgery. Maintaining close blood glucose control during surgery is essential to prevent hypoglycemia. It is best to start intravenous insulin, glucose, and potassium before surgery. To prevent hypoglycemia, close perioperative blood glucose monitoring is essential. Intravenous insulin, glucose, and potassium should be initiated before surgery. Blood glucose levels should be checked every hour during the procedure and right after. After oral intake is established, the infusion should be stopped, and regular insulin treatment should resume. The interval between ceasing intravenous insulin and starting subcutaneous insulin again should be one hour. Preoperative assessment should comprise urine ketones, serum electrolytes, creatinine measurements, and a comprehensive physical examination (particularly concerning cardiac status).
-
Patients Who Take Intravenous Insulin: Perioperative diabetes management has shifted from subcutaneous insulin therapy to intravenous insulin, glucose, and potassium infusion. The benefits of an insulin infusion regimen over subcutaneous delivery have been highlighted in several reports. Continuous glucose monitoring is essential in these patients to prevent complications during or after the procedure.
Conclusion
Hyperglycemia and high glucose variability (GV) have been shown in patients undergoing gastric bypass (GB) and other surgical procedures, which may affect eating habits and metabolic status. A thorough food diary that includes any related variables (for example, eating habits, circumstances, and emotional symptoms) is necessary for continuous glucose monitoring. This makes it possible to identify specific behaviors and dietary amounts of simple carbohydrates, which helps inform recommendations for these patients' clinical care.
