18 - Managing Type I & II Diabetes

Question 1

What is the most common cause of perioperative mortality in diabetic patients?

Test Q #1

Answer 1

CARDIOVASCULAR DISEASE

• Diabetes IS a cardiovascular disease risk factor equivalent
• It is like smoking - a very bad risk factor

Question 2

What is a major risk factor for cardiovascular disease?

Answer 2

Diabetes

- it is a RISK FACTOR

Question 3

What things can decrease complications and mortality in patiets with diabetes?

Test Q #2

Answer 3

Tight glucose control decreases complications and mortality in patients
***

KNOW THIS

Question 4

What is the goal of treating diabetic patients?

Answer 4

• prevent marked hyperglycemia, ketosis, postoperative infections, and impaired wound healing.
• prevent unrecognized and potentially fatal hypoglycemia.

Question 5

What do you need to achieve before surgery in diabetic patients?

Answer 5

Achieve blood glucose control prior to surgery

Question 6

What do you need to do to prevent proteolysis, lypolysis and ketosis?

Answer 6

Provide glucose as carbohydrate to inhibit proteolysis, lipolysis, and ketosis

How can you do this?

• Requires 150gms of glucose/day
• 1 liter of D5W = 50gms of glucose
• Provide insulin when appropriate, but prevent hypoglycemia
• Minimize protein catabolism

These things were generally emphasized (green box)

Question 7

What is the KEY to caring for surgical diabetic patients?

Test Question

Answer 7

Key is to monitor blood glucose frequently

MONITOR BLOOD GLUCOSE LEVELS CLOSELY***

Question 8

What do you need to remember about taking type 1 diabetics to surgery?

Answer 8

ALWAYS have basal insulin coverage

Do NOT withhold all insulin in a type 1 diabetic, even if they are NPO (keep pump at basal rate, stay on full dose of lantus, give 1/2 or 1/3 intermediate acting insulin and infuse with dextrose)

Question 9

What do you NEED to remember about the care of type 1 diabetic surgical patients?

Test Q #3

Answer 9

Type I diabetics always require insulin, even when euglycemic

** KNOW THIS **

So… If there was a patient having surgery (60 year old male), and he was NPO prior to surgery, the WRONG plan of action would be to hold insulin ***

Question 10

What happens when you stop basal insulin in type 1 diabetics?

Answer 10

Total discontinuation of CIII (continuous intravenous insulin infusion) is associated with hyperglycemia and ketosis

CIII is recommended for all type 1 diabetic surgical patients

Question 11

What is the most common oral medication for type 2 diabetes?

Answer 11

Metformin

Question 12

What is the function of metformin?

Answer 12

• sensitize target tissue to insulin
• inhibits hepatic glucose production
• augments peripheral glucose uptake

Question 13

Why do you withhold metformin on the day of surgery?

Answer 13

LACTIC ACIDOSIS RISK

Question 14

Describe the lactic acidosis risk associated with metformin use on the day of surgery

Answer 14

• Renal issues will increase the risk

- Don’t combine with radiocontrast dye –> need to check creatinine if you do