Preoperative evaluation of patients with diabetes
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In these annotated slides I discuss the things you need to consider in the preoperative evaluation of patients with diabetes. This sets the stage for perioperative management of diabetes. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
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Preoperative evaluation of patients with diabetes
- 1. Preoperative Evaluation of Patients with Diabetes Terry Shaneyfelt, MD, MPH Assoc. Professor, UAB Department of Medicine
- 2. Surgery results in functional insulin insufficiency
- 3. Diabetes is associated with increased risk of postoperative complications & LOS
- 4. Preoperative evaluation of the diabetic patient • Determine cardiac risk • Diabetes assessment • Type 1 or 2 • Diabetes medications • Frequency of blood glucose monitoring • Baseline metabolic control (A1C) • Hypoglycemia (frequency, severity, awareness)
- 5. Preoperative evaluation of the diabetic patient • Characteristics of surgery • Minor vs. major • Timing • Duration • Anesthesia • Regional, epidural or general
Editor's Notes
- These PowerPoints will review background information of the effects of surgery on glucose control and the risk of perioperative outcomes in patients with diabetes.
- The disruptive nature of surgery results in labile blood sugars. Surgery and general anesthesia cause a neuroendocrine stress response with release of counter regulatory hormones like epinephrine, cortisol, and glucagon. Patients might have sepsis or hyperalimentation. The end result is insulin resistance, decreased peripheral glucose utilization, impaired insulin secretion, increased lipolysis and protein catabolism- all resulting in hyperglycemia (even in patients without diabetes).
- Diabetes has been shown to increase the risk of postoperative complications and length of hospital stay. This figure shows the results of an observational study demonstrating just how much risk of a variety of outcomes is increased.
- Preoperative assessment of patients with diabetes includes an evaluation of cardiac risk (using either the Gupta criteria or the revised cardiac risk index) and an evaluation of the patient’s diabetes. Type 1 diabetics need basal insulin to prevent ketoacidosis. Medications must be assessed to determine perioperative dosing. The level of control of diabetes is important. Poorly controlled blood sugars result in greater risk of complications.
- You need to assess the planned time of surgery as the duration of NPO and insulin dosing will vary based on a morning or afternoon procedure. Longer procedures are associated with greater metabolic effects Epidural and regional anesthesia have minimal effects on glucose metabolism and insulin resistance.