mortality. Poor perioperative glycemic control: ↑ risk of adverse outcomes. There is a strong correlation between perioperative hyperglycemia and increased complications, especially nosocomial infection. Pre-existing metabolic disturbances are exacerbated by surgery. Metabolic impact of surgery may worsen glycemic control. Metabolic worsening can result in increased mortality, morbidity and length of hospital stay.
Management strategy: Baseline assessment: History and examination, type of diabetes, glycemic status, current medications, associated complications (ECG, renal and cardiac functions); Goals: Maintaining euglycemia with avoidance of hypoglycemia, prevention of ketoacidosis, maintenance of fluid and electrolyte balance; Target: aim to keep the glucose readings between 140 and 180 mg/dL; Ideally, all patients with diabetes mellitus should have their surgery prior to 9 AM to minimize the disruption of their management routine while being NPO; IV insulin infusion is usually required for long and complex procedures (e.g., CABG, renal transplant or prolonged neurosurgical operations) or any patient with poor glycemic control. Patients with type 2 diabetes on OADs or noninsulin injectables - hold these agents on the morning of surgery: Correction insulin (usually 6 hourly) until the patient is eating and either can resume oral agents/noninsulin injectables or a basal-bolus insulin regimen is initiated.
Patients who are on insulin can continue with SC insulin perioperatively at a reduced dose (rather than an insulin infusion) for procedures that are not long and complex (e.g., no more than one or two missed meals).
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