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Diabetes Mellitus, the most commonly encountered perioperative endocrinopathy, continuous to increase dramatically in prevalence
Diabetic patients commonly have microvascular and macrovascular pathology that influences their perioperative course and critical illness and increases morbidity and mortality rates during hospitalization.
Long-term Complications of Diabetes Mellitus 10% of all diabetics develop renal disease usually resulting in dialysis Diabetics are up to 4 times more likely to have heart disease and up to 6 times more likely to have a stroke than a non-diabetic
If the patient is for minor surgery the OHA is omitted on the day of surgery and they can then be treated without insulin, with close observation and conversion to GIK if the glucose rises above 8.0 mmol/l
If the patient is for major surgery the patient should be established on insulin pre-op, even if well controlled. There is good evidence that continuous I.v insulin infusions are superior to intermittent s.c.boluses and also to I.v. boluses
GIK systems (Alberti regimen) are relatively safe as they provide insulin and dextrose together, preventing potential disasters.
As long as the patient is receiving enough glucose, insulin and potassium any other fluids needed intraoperatively should be non-glucose containing
It has been suggested that lactated Ringers should not be used, as lactate is a gluconeogenic precursor that is rapidly metabolized especially in a starved or catabolic state. This may result in higher blood glucose concentrations, and should be avoided