Difference between revisions of "Diabetes mellitus"

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* No overt indications for case cancellations for poorly controlled diabetes
* 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
* Consider case delay alongside surgery team if BG > 200 mg/dL and case is elective and a prothesis or synthetic biofilm will be inserted into the patient during surgery (i.e. prothesis, intraocular lens, joint replacement, graft, etc).
* Obtain pre-operative HgA1c if one has not been obtained via primary care in last 3 months prior to surgery
** If HgA1c > 8.0 - evidence shows greater incidence of post-operative hyperglycemia during patient recovery
 
===== <u>Pre-operative medication adjustments</u>: =====


===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===
===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===

Revision as of 11:34, 12 July 2021

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

Article quality
Editor rating
Unrated
User likes
0

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 alongside surgery team if BG > 200 mg/dL and case is elective and a prothesis or synthetic biofilm will be inserted into the patient during surgery (i.e. prothesis, intraocular lens, joint replacement, graft, etc).
  • Obtain pre-operative HgA1c if one has not been obtained via primary care in last 3 months prior to surgery
    • If HgA1c > 8.0 - evidence shows greater incidence of post-operative hyperglycemia during patient recovery
Pre-operative medication adjustments:

Intraoperative management

Postoperative management

Related surgical procedures

Pathophysiology

Signs and symptoms

Diagnosis

Treatment

Medication

Surgery

Prognosis

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.[1]

References

  1. "National Diabetes Statistics Report, 2020 | CDC". www.cdc.gov. 2020-09-28. Retrieved 2021-07-12.