There is an increased risk for peri-operative complications in those with diabetes undergoing surgery. Catabolic stress of surgery (in those with or without diabetes) increased secretion of cortisol, catecholamines, glucagon and growth hormone (counter-regulatory hormones) increased glycogenolysis, gluconeogenesis, lipolysis, proteolysis and insulin resistance need more insulin to counteract. In those with diabetes this will result in diabetic ketoacidosis need for careful perioperative planning and management.
• close liaison with anaesthetist and recovery room staff; approach and management of patient needs specialist individualisation
• optimal glucose control prior to surgery (may depend on urgency of surgery) may need earlier admission to hospital to for further assessment and optimal glucose control
• correct electrolyte imbalances and improve nutritional status prior to surgery
• beta-blockers used in high risk patients (decreased risk of myocardial infarction and death)
• should be operated on at start of surgical list
• anaesthesia masks symptoms of hypoglycaemia
• management during surgery has to be flexible and have feedback mechanisms in place; often aim to keep blood glucose 7-11mmol/l (lower increases risk for hypoglycaemia; higher increases urine output dehydration)
• if diet or oral agent control – monitor blood levels hourly pre- and post-operatively; discontinue long acting agents several days prior to surgery – use insulin and/or short acting agents
• if insulin treated – use IV dextrose and insulin peri-operatively; regular monitoring of plasma electrolytes
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