Surgery in the diabetic patient

The condition of the diabetic patient--reduced availability of insulin and an enhanced reaction to the counter-regulatory hormones elicited during major surgical stress--necessitates the administration of insulin to prevent hyperglycemia, fat mobilization and ketosis, and wastage of body protein. Crucial items in management are the maintenance of fluid and electrolyte balance and prevention of infection. The recognition of diabetes-related complications, particularly those involving the cardiovascular system, will forestall problems related to these conditions during the perioperative period. For both type I and type II diabetes the use of intravenous glucose-insulin infusion provides a safe and effective method for management during surgery. During surgery, monitoring of blood glucose concentration determines the adequacy of insulin dosage, which can be adjusted to maintain glucose concentrations within the desired range. With this system, the hazards of hyperglycemia are avoided and significant hypoglycemia is rarely encountered. For elective operations as well as for emergency surgical procedures, this method can provide a simple and effective regimen for use in most hospitals.