Management of the diabetic surgical patient. A systematic but flexible plan is the key

Guidelines for Perioperative Management of the Diabetic Patient

Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes.

Current perioperative treatment of patients with type 1 and type 2 diabetes

Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. Diabetic patients must be carefully evaluated for cardiovascular risk, keeping in mind micro- and macroangiopathic diabetic complications. Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.

Surgery and diabetes

Medical treatment of the diabetic patient undergoing surgery is described. Intravenous insulin is emphasized for all patients, except the type II diabetic patient controlled on diet therapy. Frequent metabolic monitoring of the patient is critical to a successful outcome. Bedside glucose monitoring is the most important advance during the last decade for monitoring the patient.

Surgery in patients with endocrine dysfunction

Patients with diabetes mellitus, thyroid dysfunction, and adrenal suppression from exogenous steroid therapy frequently undergo surgery. An understanding of the pathophysiology of these disorders enables the medical consultant to have valuable input into the preoperative evaluation and perioperative management of these patients. This article serves as a practical guide in following such patients through surgery, thereby decreasing overall morbidity and mortality.