This is a lengthy read but very informative and I hope that ghost readers such as a diabetic patient read this thoroughly.
Recently a clinic brought up a topic on transplanting diabetic patients (strip/FUE). The thrust of the thread was that they should not be transplanted. After a lengthy debate the clinic finally conceded that they could “possibly” proceed with the surgery. Well I collected some facts from my clinic as well as a few clinics I worked for here in the US and Europe.
Today we had yet another type I diabetic.
Type I diabetic has insulin dependancy. In other words… they must inject insulin daily or have an insulin pump that infuses the proper amount of insulin to control blood sugar/glucose to live.
Type II diabetic controls their glucose/blood sugar without insulin… mainly by pills or diet.
Type I is harder to control their glucose/blood sugar. Because of this, they sometimes have problems with healing because their circulation and especially at the surface of the skin or scalp is compromised.
Anyway… since we had a a type I today I wanted to discuss how we managed this patient… how the physician pre-planned the surgery… how every pre-operative, intra-operative, and post operative planning was taken into consideration.
In my opinion as well as many other clinics and physicians… a diabetic patient should always have the opportunity for a hair restoration.
Dr. Paul Shapiro’s summary of how to approach a diabetic patient. His words to me and summarized.
Laxity… A diabetic patient should perform stretching exercises for a strip excision. If he/she does not then they should have a good laxity in the donor region. The strip excision width will be taken very conservatively. This is to ensure not to compromise the surrounding tissues in terms of blood circulation and to decrease a chance of infection or necrosis. In FUE the laxity is irrelavent.
A relatively good control by the patient of their sugar/blood glucose/insulin levels before surgery for a long period of time.
The patient must be told that because of his/her condition that they more than likely will not have a normal circulation on their recipient area. A type I may have a compromised micro-circulation. This means… and I quote from Dr. P. Shapiro, “I would NOT dense pack in any given area. The transplanted area would be more diffusely transplanted so that a compromised circulation would be able to supply the transplanted grafts. This could cause a less yield of growth.”
Check the sugar/blood glucose to see if the sugar/blood glucose is within a normal range before the surgery. Today our patient’s blood sugar/glucose was higher than normal. The patient had an insulin pump and he adjusted his insulin and we post-poned the surgery until his levels became normal.
- The blood gucose/sugar levels are monitored continuously throughout the surgery. Insulin is adjusted accordingly.
- Medications that would cause a problem with diabetic patients are withheld. Steroids such as prednisone, etc are not given.
- Fully disclose to the patient to continue to monitor his blood glucose/sugar closely and make the necessary adjustments during this time and especially since he/she underwent a trauma of a strip/FUE.
- Fully explain to the patient that a follow up check in is imperative for the next two weeks to look for signs of decreased healing, infection, fever, etc… And if anything seems abnormal then they must call the HT physician or personal physician for further instructions.
So in a quick summary… At least at our clinic and a few of my previous clinics I have worked for… it is possible to transplant a diabetic patient. A cautious approach must be observed. A clear and precise expectation must be conveyed to the patient, i.e. A less density transplant(no dense packing), less grafts per surgery(3000 or less in the strip excision as per Dr. P. Shapiro), and a possible less yield of growth.
If this simple protocol is executed then the diabetic should have an option of a hair restoration.
The picture depicts a diabetic patient with a common insulin pump seen here in the US and Europe.