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Diabetes, Carbs and Foot Surgery: How does surgery make your blood sugar go up?

I recently did a minor procedure (verruca needling) on a patient who has Type 1 diabetes and although his blood sugars are usually excellent, he found they were harder to control in the week following his procedure. Let's explore why...

What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune condition that attacks your pancreas and prevents you from producing insulin. It usually occurs in childhood, but can occur during one's teens or even later in life.

A man in a blue shirt and tan chinos about to prick his finger so he can check the level of sugar in his blood.
A gentleman about to test his blood sugar

The problem with not producing insulin:

To simplify human physiology, insulin is a hormone which is produced by your body and tells your cells to absorb sugar from the blood. If you've ever had a partner who would wake up a bit ratty, but they improved when given chocolate, then their blood sugar was probably a bit low. Or, they totally played you. Given the choice, I'd suggest believing in the chocolate. Anyway...

When your body doesn't produce insulin, the insulin has to be provided for it. This means that, if you need lots of sugar to go into lots of cells, then the body needs to produce lots of insulin to tell the cells to open the door for the sugar.

The problem being that if you have too much insulin floating around, with not enough sugar in the system, the cells get hungry for sugar (so sugar goes low) and if you have too much sugar floating around at the wrong moment without the insulin, then the sugar can start to do damage to your body.

It then get's more complicated...

What is sugar? What are carbs? What is love? Baby don't hurt me, no more.

Sorry for the Haddaway reference, it popped into my head, so I thought I'd share.

Carbohydrates are 'chains' of carbon, hydrogen and oxygen which are short or long. The long ones tend to be the more boring kinds - like rice or potatoes, whilst the short chain carbohydrates are the sugars. Whenever we eat anything, the body digests it, meaning it breaks it down. So, for people with diabetes who need to use insulin, they need to time when they take the insulin so that it's around to let sugars which have been broken down by the longer chain carbohydrates into the cells.

So, why does foot surgery cause high sugars for people with Type 1 diabetes?

Well, this is where we have to do some thinking:

Unless they know to do so, their diet tends to remain the same

For people with Type 1 diabetes, they live their life trying to maintain control of their sugar levels, and this often means that they try to avoid varying their diets too much. This means...

They continue to consume their usual diet, even after foot surgery

This can mean a couple of things:

  1. They consume more calories than they are burning

  2. They use the same insulin doses as usual

They might even be consuming more calories than usual

After all, what's better than a bag of crisps when all you can really do is sit around. Or munch on some Jelly Babies...! Eating out of boredom is a very real issue for people and one that, can be dealt with through being aware we do it.

An incredibly bored looking man who is, quite neatly, stacking pencils on his desk

So, in summary:

The patient who has foot surgery and then sits around eating as they usually would but exercising a fraction of what they usually would (or maybe should), will then find that their body doesn't process those sugars its has made quite so quickly or readily and doesn't know what to do with them, or it might overcorrect and just filter them out in your wee. Either way, by having foot surgery, one of the major regulators in the chemical balance of your body is altered because you cannot mechanically (through movement) reduce those sugar levels and so the sugars sit higher.

If you are having foot surgery, particularly a more major type, like for bunions or Morton's Neuromas, then you should think carefully about how to keep active in the weeks after surgery, both mentally and physically. Battling boredom is an issue, and ensuring that you have the resources to deal with that boredom is key. (Note: Resources do not include Pringles, Jaffa Cakes or any other tasty treats!). Likewise, finding ways to get some blood pumping is important as it reduces your risks for blood clots as well as maintaining your sanity.

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