Surgery diabetic patients

Blood glucose control When diabetic patients are exposed to stress such as fever, trauma, infection or surgery, a temporary loss of control of blood glucose may occur. At such times, temporary insulin therapy may be necessary. 

Highly purified (single component) and human Insulins Local insulin allergy, immunologic insulin resistance, injection-site lipodystrophy temporary insulin use (ie, surgery, acute stress type 2 diabetes, gestational diabetes) newly diagnosed diabetic patients. 

Loss of blood glucose control When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue the drug and give insulin. Disulfiram-like syncframe. A sulfonylurea-induced facial flushing or breathlessness reaction may occur when some sulfonylureas are administered with alcohol. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) Water retention and dilutional hyponatremia have occurred after administration of sulfonylureas to type 2 diabetes patients, especially those with CHF or hepatic cirrhosis. 

Fumary AP, Kerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Annals of Thoracic Surgery 1999, 67, 352-360. 

Jellish WS, KarthaV, Fluder E, and Slogoff S. Effect of Metoclopramide on Gastric Fluid Volumes in Diabetic Patients Who Have Fasted Before Elective Surgery. Anesthesiology 2005 102 904-909. 

Weintraub WS, Stein B, Kosinski A, et al. Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease. J Am Coll Cardiol 1998 31 10-19. 

Disorders of the foot are among the most common complications of diabetes, accounting for as many as 20% of all hospitalizations in diabetic patients at an annual cost of 200 to 350 million. Approximately 25% of diabetic patients experience significant soft tissue infection at some time during the course of their lifetime. Approximately 55,000 lower extremity amputations, often sequelae of uncontrolled infection, are performed each year on diabetic patients this represents 50% of all nontraumatic amputations in the United States. Between 10% and 20% of diabetics will undergo additional surgery or amputation of a second limb within 12 months of the initial amputation. By 5 years, this increases to 25% to 50%, with death reported in as much as two-thirds of patients. ... 

The NRC classification system does not account for the influence of underlying patient risk factors for SSI development, instead categorizing the risks for SSIs simply based on a specific surgical procedure. Disease states and conditions known to increase SSI risk are presented in Table 121-2. Preexisting distal infections increase SSI rates and should be resolved prior to surgery whenever possible. Diabetic patients have an increased risk of SSIs, especially those with uncon-... 

Meier 11, Weyhe D, Michaely M, Senkal M, Zumtobel V, Nauck MA, et al. Intravenous glucagon-like peptide 1 normalizes blood glucose after major surgery in patients with type 2 diabetes. Crit Care Med 2004 32 848-851. 

Belhoula M, Ciebiera JP, De La Chapelle A, Boisseau N, Coeurveille D, Raucoules-Aime M. Clonidine premedication improves metabolic control in type 2 diabetic patients during ophthalmic surgery. BrJAnaesht (2003) 90,434-9. 

Kongtahworn, C., Foster, E., Mason, E. F.. and Printen, K. J. (1973) Heparin-induced elevation of free fatty acids in diabetic patients. Surgery, 74, 30. 

Check the patient s general health including previous surgery, presence of diabetes mellitus, or medications that may cause or worsen voiding symptoms. 

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