Guidelines for Perioperative Management of the Diabetic Patient

Abstract

Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes.

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

“…As such, it is important to maintain tight control of glucose levels in the perioperative setting. Anesthesia literature suggests maintaining a blood glucose level between 150 and 200 mg/dL intraoperatively and 140-180 mg/dL postoperatively [14]. Strategies to maintain appropriate blood glucose levels include utilizing diabetes education services preoperatively, avoiding dextrose-containing IV fluids, and involving a surgical co-management team in the postoperative care of the patient to assist with controlling blood glucose levels.…”

Management of Chronic Medication Therapies in the Perioperative Period: a Literature Review

“…Although currently there is no consensual target for glucose levels, in general the literature suggests keeping them between 150 and 200 mg/dL (8 to 11 mmol/L) during the perioperative period [12].…”

“…Metformin should be discontinued before surgery due to renal function impairment and increased risk of lactic acidosis [12,13]. As for thiazolidinediones, these are generally discontinued as they may cause fluid retention in the postoperative period [12,13].…”

“…As for thiazolidinediones, these are generally discontinued as they may cause fluid retention in the postoperative period [12,13]. Alpha glucosidase inhibitors act on intestinal mucous membranes, lowering the absorption of glucose after meals.…”

“…Alpha glucosidase inhibitors act on intestinal mucous membranes, lowering the absorption of glucose after meals. However, in preoperative fasting states this drug has no effect and thus should be discontinued until the patient resumes eating [12,13]. Sulfonylureas trigger insulin production and may induce hypoglycaemia in a fasting preoperative patient, and should therefore be discontinued [13].…”