The Medical Management of Diabetic Patients during Surgery

Introduction Diabetics are subject to all the surgical conditio ns affecting non-diabetics and in add ition are more prone than the general populat ion to a number of comp lications such as coronary artery disease, pe ripheral vascular disease , neuropathic ulcers and proliferative retinopathy which may , during their course , require surgical intervention . The diabetic has a 50 % chance of requiring surgery during his lifetime and a quarter of all hospitalizat ions in diabetics involve surgery . For these rea sons , hea lthcare personnel are frequently called upon to care for diabetic surgical pat ients . When preparing diabetic patients for elect ive surgery , three general areas are of importance: The first is the usual surgical precautions of evaluation of electrolytes , fluid balance , hematologic, and hepatic status. The second is the evaluation of conditions seen in the general population but see n more freq uently in diabe tics. They include cardiovascular disease , hyperten sion , cerebrovascular disease , and renal insufficiency. The third is the management of the diabetes itself including the nutritional status . The diabetic undergoing elective surgery should be admitted to the hospital one to two days prior to surgery so that medical problems can be evaluated , and diabetes control established .