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Pre-Surgical Evaluation of Diabetic Patients

	Introduction

 
In the general population, there are numerous indications for surgery, such as cardiac, vascular, abdominal, and orthopedic problems. People with diabetes may also face surgery for these common problems, as well as for procedures prompted by the long-term complications of their disease.

This high-risk group will undergo cardiovascular and ophthalmological procedures at a greater rate than will their nondiabetic peers. They may also require a transplant associated with diabetes, such as a kidney transplant in the setting of renal failure or a pancreas transplant. Furthermore, diabetic complications may require penile prosthesis implantation, ulcer debridement, or limb amputation.1 During the postoperative period, diabetic patients face poor wound healing, increased incidence of acute renal failure, and increased infection rates.

When diabetic patients enter the surgical arena, they face several challenges that are not present in nondiabetic patients. Many of the problems arise because diabetic patients are not able to maintain a balance between insulin and its counterregulatory hormones.

On one side of the equation, insulin acts as the primary anabolic hormone that promotes glucose uptake by the muscle and fat cells while decreasing glucose production by the liver. This occurs because insulin suppresses gluconeogenesis and glycogenolysis. The net effect is to lower blood glucose levels.

The counterregulatory hormones, including epinephrine, glucagon, cortisol, and growth hormone, have the opposite effect. They raise blood glucose by stimulating glycogenolysis and gluconeogenesis in the liver; by increasing lipolysis and ketogenesis; and by inhibiting glucose utilization by muscle and fat.

Surgery and anesthesia provoke a neuroendocrine stress response, which releases these counterregulatory hormones and causes hyperglycemia and increased catabolism. The magnitude of the response depends on the severity of surgery and on complications such as sepsis, hypotension, hypovolemia, and acidosis.1

Nondiabetic patients can increase insulin secretion and maintain glucose homeostasis throughout a surgical procedure. Diabetic . . . [Full Text of this Article]

	Avoiding Hyperglycemia Is Important

 

	Presurgical Evaluation

 

	Preoperative Evaluation of the Cardiovascular System

 

	Additional Preoperative Evaluations

 

	Adjusting Diabetes Medications for Surgery

 

	Postoperative Preparation

 

	Summary

 

	Footnotes

 

	REFERENCES

 

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