Perioperative Diabetes mellitus management
1. PERIOPERATIVE MANAGEMENT OF DIABETES MELLITUS SPEAKER Dr. DHARMRAJ SINGH MODERATOR Dr. SHASHI PRAKASH
2. INTRODUCTION Patients with diabetes have higher incidence of morbidity and mortality. Poor peri-operative glycaemic control increases the risk of adverse outcomes. Treatment of post-operative hyperglycaemia reduces the risk of adverse outcomes.
3. CRITERIA FOR DIAGNOSIS OF DIABETES 1. Symtoms of diabetes plus random plasma glucose level >200 mg/dL (11.1 mmol/L) 2. Hemoglobin A1C ≥ 6.5 % 3. Fasting plasma glucose level ≥ 126 mg/dL (7.0 mmol/L) 4. Two-hour plasma glucose level ≥ 200 mg/dL (11.1 mmol/L) American Diabetes Association
4. METABOLIC SYNDROME At least three of the following Fasting plasma glucose ≥ 110 mg/dl Abdominal obesity (waist girth > 40 [in men], 35 [in women]) Serum triglycerides ≥ 150mg/dl Serum HDL cholesterol < 40 mg/dl (men), <50 (women) BP ≥ 130/85 mm Hg Insulin-resistant syndrome is a constellation of clinical & biochemical characteristics frequently seen in pt with or at risk of type 2 diabetes.
5. THE METABOLIC RESPONSE TO SURGERY AND THE EFFECT OF DIABETES Metabolic effects of starvation: 1. Period of starvation induces a catabolic state. 2. It will stimulate secretion of counter-regulatory hormones . 3. It can be attenuated in patients with diabetes by infusion of insulin and glucose (approximately 180g/day). Metabolic effects of major surgery. It causes neuroendocrine stress response with release of counter- regulatory hormones (epinephrine, glucagon, cortisol and growth hormone) and of Continue reading