Current trends in management of hyperglycaemia in surgical patients with diabetes mellitus: a review

A large amount of clinical evidences demonstrates a clear association between long-term and/or stress-related hyperglycaemia, and development complications after surgery. The incidences perioperative hyperglycaemia are demonstrated in 20–80 % all cases depending on the type elective surgery, with highest rate registered cardiac most studied pathophysiological Diabetes Mellitus (DM) patients are; activation polyol pathway, diacylglycerol/protein kinase C hexosamine pathways, advanced glycation product formation, oxidative stress. uncontrolled during surgery instigates: osmotic diuresis further fluid electrolyte imbalance, increased gluconeogenesis glucogenolysis, breakdown fats into free fatty acid glycerol, proteins amino acids, increases generation pro-inflammatory cytokines. All these changes may lead to diabetic ketoacidosis, immune deregulation insulin resistance. Some investigations seems indicate that anaesthesia propofol have some advantages keeping stable blood sugar over inhalational agents. Two trials comparing influence different anaesthetic agents glycaemic status currently underway. For better management under we proposed several important practical principles.