My husband has Type 2 diabetes. He was diagnosed in 1997 and began taking metformin in February of 2001. In the near future he may need surgery to repair a hernia. What are the statistics on individuals who were non-insulin dependent prior to surgery and become insulin-dependent after surgery? We are both concerned and my husband may put off the surgery because he is very concerned that he will become an insulin-dependent diabetic after the surgery. Please advise.

Thanks very much for your question. I can understand your husband's concern about becoming insulin dependent after a hernia operation, but I am pleased to say that, in my experience, this is extremely unlikely.

I am making some presumptions about your husband's health and diabetes when I reassure you about this issue:

First, I presume that the hernia is an inguinal hernia (groin or scrotum). Nowadays, surgical repairs of inguinal hernias are done under light anesthesia and the surgery is relatively uncomplicated. The time in the hospital is usually short (in fact, the operation is often done in day-surgery and the patient goes home that day!) and the recovery time after the operation is usually brief. While we sometimes see a mild elevation of glucose during and after anesthesia and surgery due to the physical "stress" of the procedure, this is almost always temporary and resolves in a few days. It usually doesn't require any medication changes and it does not make the person with diabetes become insulin-dependent permanently.

Second, I am presuming that his Type 2 diabetes has been well-controlled with metformin (Glucophage) alone. Using only one good medication to achieve good control would indicate that his pancreas is making a reasonable amount of insulin and that the metformin is acting to allow his insulin to act effectively in keeping the blood glucose within target range. The chance of your husband's diabetes converting to a "no insulin" or "inadequate insulin" production state after an inguinal hernia surgery is therefore very unlikely.

You and your husband should also consider the downside of not repairing the hernia. This could create the risk of serious problems developing that might mean an urgent or emergency operation -- for example, if the hernia became trapped in the scrotum or strangulated. In my opinion, an elective hernia surgery is far better in most cases.

I would suggest that you discuss your concerns with your husband's primary care physician and with his hernia surgeon. I think that their advice would be very useful to you in making the correct decision. Again, thanks for your question and let us know how you are doing in the future.

-- Dr. Bruce Biller is an internist with subspecialty training in endocrinology and a special interest in diabetes. He is director of the Harvard Business School Health Services and physician to the Harvard University Health Services.

First published February 12, 2003
Last updated February 11, 2008
Copyright © 2003 Consumer Health Interactive