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The diabetic patient. Should you transplant?

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.

Pre-operatively:

  1. 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.

  2. A relatively good control by the patient of their sugar/blood glucose/insulin levels before surgery for a long period of time.

  3. 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.”

  4. 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.

Intra-operatively:

  1. The blood gucose/sugar levels are monitored continuously throughout the surgery. Insulin is adjusted accordingly.
  2. Medications that would cause a problem with diabetic patients are withheld. Steroids such as prednisone, etc are not given.

Post-operatively:

  1. 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.
  2. 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.

» 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.
»
» Pre-operatively:
»
» 1. 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.
» 2. A relatively good control by the patient of their sugar/blood
» glucose/insulin levels before surgery for a long period of time.
» 3. 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.”
»
» 4. 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.
»
» Intra-operatively:
»
» 1. The blood gucose/sugar levels are monitored continuously throughout the
» surgery. Insulin is adjusted accordingly.
» 2. Medications that would cause a problem with diabetic patients are
» withheld. Steroids such as prednisone, etc are not given.
»
» Post-operatively:
»
» 1. 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.
» 2. 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.

Nothing is simple when it comes to diabetes, there are a lot of potential complications that can happen to a diabetic patient even if all the correct protocols are followed.

I concede johnp. You are right. Nothing is simple for a diabetic transplant patient. I am glad you corrected me. And this is why I brought up this thread… This should never be taken lightly but again a diabetic person should have options in this field. :slight_smile:

My opinion is that if a diabetic patient would choose foods extremely low on the glyceymic index preferably moving towards a ketogenic type diet than high levels of blood glucose and the problems they present with healing would not be as much an issue. Something else that would be good for non diabetic patients to know is that even though your body is producing insulin when eating all those cheap foods that are causing a constant spike in blood glucose levels you are creating loads of inflammation which in not good for healing. So is it any wonder many patients often experience poor healing. Keep in mind is that even though a food has a low glycymic index it could still have a high insulin index, particularly artificial sweeteners. The body’s receptors sense something sweet and when blood glucose levels drop due to the insulin being produced in the non diabetic you can easily have a hypoglyceymic reaction resulting in dizziness, food cravings, irritability, depression etc. In fact this is what most obese people fail to understand about drinking that diet Coke it’s helping to fuel your hunger and in fact helps to make you fatter and not thinner while at the same time a likely cause of depression.

Insulin could best be described as the fat storage and aging hormone. The less insulin you have floating around in your body the better off you will be.

I would suggest some eggs for the patient’s lunch and maybe some hard cheese. Although the patient is wearing an insulin pump it’s probably best to keep their blood glucose levels on an even keel. Any type of sandwich using bread regardless of if it is whole grain or white will cause a spike which is something that should be avoided.

I have even heard of clinics giving patients pizza for lunch which would also be a bad idea.

» I have even heard of clinics giving patients pizza for lunch which would
» also be a bad idea.

Guess what - I have even heard of clinics giving patients pro bono hair transplants – especially those who are kings of hair loss boards since many years, of course. Makes more sense than a pro bono pizza …

» » I have even heard of clinics giving patients pizza for lunch which would
» » also be a bad idea.
»
» Guess what - I have even heard of clinics giving patients pro bono hair
» transplants – especially those who are kings of hair loss boards since many
» years, of course. Makes more sense than a pro bono pizza …

I’m a type 1 diabetic and cautiously considering a transplant.
so it’s just great when a supposed Intelligent poster comes to a thread simply
to hurl insults around.

@hairtech_smg is there anyway I can contact you privately to find out more information regarding this topic.

@hairtech_smg is there anyway I can contact you privately to find out more
information regarding this topic.

sure… stortiz1@hotmail.com

» I’m a type 1 diabetic and cautiously considering a transplant.
» so it’s just great when a supposed Intelligent poster comes to a thread
» simply
» to hurl insults around.

Yes I agree and that’s why posting here is often a waste of time. Instead of intelligent debate and information it has become just nonsense.

I would suggest “Dr. Bernstein’s Diabetes Solution” as a good book for learning how to better control blood sugar levels and sometimes being able to greatly reduce or in some cases eliminate insulin. I am not a diabetic but I have read it due to my interest in the relationship between food and the insulin index and glycemic index. Some of it I don’t necessarily agree with like the use of artificial sweeteners but overall it was good information plus it does reference some books that I have read that are much more informative. Dr. Bernstein was diagnosed with diabetes about 60 years ago which led him to switch his career path which was training as an engineer to becoming a doctor of diabetes and at the age of 80 somewhat of an expert as he has the disease himself.

The problem with the ADA is too much of the information has been bought and paid for like many other organizations including hair loss forums.

The diet of a diabetic patient definitely should be considered during a hair transplant.:slight_smile:

Jackie1,

I hope you received my email.:slight_smile:

» Jackie1,
»
» I hope you received my email.:slight_smile:

Thanks yes i did i sent the info onto Matt Zupan

The reality is that you can take all the precautions in the world but before the surgery, the doctor will still insist that the patient signs a disclaimer so that if anything goes wrong, whether diabetes related or not, the doctor will not be responsible.

Good point daamrack… but not at the clinic i work for now… The clinic I worked for two clinics back had those shady rules.

Not sure what happened to that other diabetic thread, oh well just business I suppose. I think since we are dealing with doctors here it would better serve the diabetic patient for the doctor to help that same patient obtain better control of their diabetic situation with the patient’s welfare in mind. That being said the explosion of diabetes across the world is diet related so that would be a good place to start.

I also believe that clinics should probably be more concerned with patients experiencing metabolic syndrome on their way to diabetes as their bodies have constant low grade inflammation which is not good for healing and they represent a much higher percentage of patients. Poor healing happens for a reason but the problem is most doctors are clueless to the why.

» Not sure what happened to that other diabetic thread, oh well just business
» I suppose. I think since we are dealing with doctors here it would better
» serve the diabetic patient for the doctor to help that same patient obtain
» better control of their diabetic situation with the patient’s welfare in
» mind. That being said the explosion of diabetes across the world is diet
» related so that would be a good place to start.

Wishful thinking. Hair transplant doctors have no business giving medical advice to diabetic patients. Besides, for type II diabetes (which is what most people have), all you need is diet and exercise to keep things under control. Doctors will only give you drugs that will cause you to become even more diabetic.

Abcxyz I agree completely but the whole system is rigged and 99.9% of the population will tell you that you are not a doctor so you don’t know what you are talking about. That is how clueless people have become. They are all like Tom Cruise waiting to be teleported to planet Xenu, they just don’t get it and don’t see just how conditioned they have become.

All one needs to do is look at the American Diabetes Association, who sponsors them and what they recommend. They have been completely co-opted by those that want to control the information so they can keep on profiting and to some extent hair transplantation and the forums work the same way.

I agree… I would put everything I own on the fact that 99.9% of the clinics that post on this forum and most all other forums, have an agenda to generate profits. The 0.1% of the people who post on these threads are people actually trying to get information on hair transplants and to just find the truth. What is left who post on these sites is 0.1%… These are genuine posters like myself, Topcat, skywalker, etc… not many.

These forums in the beginning helped the hair transplant industry… then later was corrupted by greed.

However I have full confidence that most of the people WHO READ these forums… ghost readers… those who read and not post… know the reality… they see through the B.S., and are just trying to figure out which clinics are the ones to consider.

This is why I continue to be apart of that 0.1% poster. Just to tell the truth, answer questions, and give my honest opinion despite the clinic I work for.

» Not sure what happened to that other diabetic thread, oh well just business
» I suppose. I think since we are dealing with doctors here it would better
» serve the diabetic patient for the doctor to help that same patient obtain
» better control of their diabetic situation with the patient’s welfare in
» mind. That being said the explosion of diabetes across the world is diet
» related so that would be a good place to start.
»
» I also believe that clinics should probably be more concerned with patients
» experiencing metabolic syndrome on their way to diabetes as their bodies
» have constant low grade inflammation which is not good for healing and they
» represent a much higher percentage of patients. Poor healing happens for a
» reason but the problem is most doctors are clueless to the why.

this one ?
http://www.hairsite.com/hair-loss/board_entry-id-103869-page-0-order-last_answer-category-2.html

I still think the doctor should flat out refuses all diabetic patients. Someone brought up a good point about all the legal papers and disclaimers that a patient has to sign before the surgery, the patient is gambling with his life while the doctor has no liability.

Thanks Johnp I thought that thread was removed. The fact is that the majority of diabetes is self inflicted no different than how lung cancer is self inflicted with cigarettes. It’s a better idea for the cigarette smoker to stop smoking first and foremost as it is for a diabetic to stop stuffing their face with sugar and it’s cheap equivalents. That’s hard straight advice and doctors are not only clueless, it’s to their benefit to have a patient that requires a lifetime of treatment. It’s called recurring income.

good points…