Diabetes mellitus

Diabetes mellitus

Anesthetic relevance	High
Anesthetic management	Preoperative HgA1c value Preoperative glucose value Preoperative medication adjustment Insulin administration Post-operative glucose
Specialty	Endocrine
Signs and symptoms	Excessive thirst Polyuria Polydypsia Glucosuria Peripheral neuropathy Ocular degeneration Cardiovascular disease
Diagnosis	HgA1c Fasting glucose
Treatment	Oral anti-hyperglycemics Exogenous insulin administration
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Diabetes is an endocrine, metabolic disorder marked by high levels of blood glucose. Three classifications of diabetics exist:

1. Type 1 Diabetes, where an immune mediated destruction of pancreatic beta cells occurs causing a total reduction in endogenous insulin and thus causing hyperglycemia
2. Type II Diabetes, where patients experience increasing insulin resistance for the level of endogenous insulin thus causing hyperglycemia
3. Gestational Diabetes in which hyperglycemia occurs in the second or third trimester of pregnancy.

The diagnosis of diabetes is made based on fasting blood glucose levels and hemoglobin A1c levels. The diabetic population in the United States is both increasing in incidence and prevalence within the last decade. This disease affects multiple organ systems that have anesthetic implications including cardiovascular health, renal disease, peripheral neurologic function, and gastrointestinal emptying requiring preoperative optimization and intraoperative control.

Anesthetic implications

Preoperative optimization

• No overt indications for case cancellations for poorly controlled diabetes
• Consider case delay if cases are elective and a prothesis or synthetic biofilm will be inserted into the patient during surgery

Epidemiology

The diabetic population in the United States is both increasing in incidence and prevalence within the last decade. According to the 2017 National Diabetes Statistics Report from the Center for Disease Control (CDC), 10.5% of the U.S. population has diabetes with an estimated 21.4% of those who have the disease are still not diagnosed.