Perioperative Management of Diabetes -- American Family Physician
نویسنده
چکیده
www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 93 eral insulin resistance, increased hepatic glucose production, impaired insulin secretion, and fat and protein breakdown, with potential hyperglycemia and even ketosis in some cases. The degree of this response depends on the complexity of the surgery and any postsurgical complications. In addition to counter-regulatory hormone excess and relative insulin deficiency, fasting and volume depletion contribute to metabolic decompensation. Diabetic ketoacidosis occurs infrequently in patients with type 2 diabetes, but hyperglycemic hyperosmolar nonketotic states are well described. The latter are characterized by extreme hyperglycemia, hyperosmolarity, volume depletion, and associated changes in mental status resulting from inadequate insulin action, osmotic diuresis, fluid losses from surgery or overuse of diuretics, and volume under-replacement. In patients with type 1 diabetes, diabetic ketoacidosis may develop in the absence of severe hyperglycemia because of inadequate insulin availability during a time of increased demand. Hyperglycemia inhibits host defenses against infection, including many leukocyte functions. Hyperglycemia also impairs wound healing because of its detrimental effects on D iabetic patients who require surgery present special challenges in perioperative management. Special attention must be paid to prevention and treatment of metabolic derangements. Vigilance for the development of acute complications that lead to higher rates of surgical morbidity and mortality is also critical.
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