Perioperative management of the diabetic patient

The diabetic patient has major surgery more frequently than nondiabetic patients. Although many of these operations are done on an elective basis, desirable perioperative control of blood glucose (ranging from 120-180 mg/dL) remains a therapeutic challenge. In planning the management, the type of diabetes, current treatment, the degree of recent control, the presence of complications, and the type of surgical procedure must all be considered. All insulin-dependent patients and many non-insulin-dependent patients need insulin therapy perioperatively. The variable stress associated with major procedures makes a flexible insulin regimen desirable. This can be provided using a continuous insulin (regular) infusion system and frequent bedside blood glucose monitoring.