Summary

In study session IV you have learnt

• Diabetes mellitus is a clinical condition characterized by impairment of carbohydrate metabolism caused by an absolute or relative deficiency of insulin.
• Insulin is a small protein produced by the β cells of the islets of Langerhans in the pancreas. The most fundamental action of insulin is to stimulate increased cellular uptake of glucose. This is particularly important in skeletal muscle cells, where muscle activity also increases
• Glucagon is a polypeptide released from the α cells of the pancreas, and acts both to stimulate the release of insulin and oppose some of the effects of insulin.
• The symptoms and signs of diabetes mellitus include polyphagia, polyuria, polydipsia and ketone in urine.
• Diabetes mellitus can be treated by adjusting diet, exercise, oral hypoglycemic agents and insulin.
• Successful management of the diabetic patient depends on the proper management of the chronic complications of the disease as on acute glycemic management.
• A thorough preoperative search must be done for end-organ complications of diabetes mellitus including heart, renal, gastrointestinal, eye, airway, presence of infection and other miscellaneous problems. In addition to a thorough history and physical, a recent ECG, blood urea nitrogen, potassium, creatinine, glucose, and urinalysis are essential.
• The primary goal of intraoperative blood sugar management is to avoid hypoglycemia and unacceptably loose blood sugar control (> 180 mg/dL).
• There are several perioperative management regimens of blood glucose perioperatively plan ahead depending on your resources.
• Monitors including ECG, pulse oximeter, blood pressure, urine output, thermometer and serial measurement of blood glucose should be used. Positioning and Pressure areas should be inspected.
• Diabetic patients considered full stomach then rapid sequence induction should be used. There are no contraindications to standard anesthetic induction or inhalational agents, but if the patient is dehydrated then hypotension will occur and should be treated promptly with appropriate intravenous fluids.
• Regional techniques are useful because they get over the problem of regurgitation, possible aspiration difficult intubation and less likely in metabolic alteration.
• Diabetic emergencies such as hypoglycemia, hyperglycemia and diabetic ketoacidosis should be treated immediately