Surgery in those with diabetes

Wikis > Diabetes > Management of Diabetes Mellitus > Surgery in those with diabetes

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.

Practical implications:
• 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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