Diabetes Mellitus

The most common endocrinopathy affecting up to 7% of the population. It manifests as elevated serum glucose levels due to relative or absolute insulin deficiency.

Presents in two clinical forms:

• Type I diabetics all require exogenous insulin to control blood glucose levels and avoid diabetic ketoacidosis.

• Type II diabetics are initially treated by diet control and weight loss. With progression of disease patients require oral hypoglycemics and/or insulin.

Multi-system end-organ damage may occur. Preoperative assessment of endorgan damage guides intraoperative therapeutic intervention (Table 9.1).

Note the extent of glucose control (fasting blood glucose levels, hemoglobin A1C) and use of hypoglycemic medications by the patient.

Perioperative glucose control is best managed with a sliding scale infusion of D5W and Regular insulin. Tight control of blood glucose requires frequent monitoring of blood sugar to maintain serum glucose between 10-12 mmol/l.

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