[Diabetes and surgery I: effects on metabolic control and preoperative evaluation]

The management of diabetes mellitus before, during and after surgery represents a common challenge in clinical practice. Surgical stress promotes a sequence of hormonal changes that might cause devastating effects on the diabetic patient, and this stress depends on several factors, some of them predictable such as the type of surgical operation or the sort of anaesthesia which is applied. The glycemic control should be optimal in order to avoid the possible consequences derived from an inadequate metabolic control during the perioperative period. The knowledge of physiopathological processes involved in the effects of surgery and anaesthesia on metabolic control represents a key element for a successful management.