4 - Red Flashcards
How does the stress of surgery affect diabetes?
Increased circulating catecholamines + glucocorticoids
Causing:
Increased liver glycogen breakdown
Increased protein metabolism-derived liver glucose
Increased insulin antagonist levels
What is a counterregulatory hormone in the context of diabetes?
Hormones that oppose the action of insulin
- increased glucose by promoting glycogenolysis, gluconeogenesis, ketosis and other catabolic processes
- in healthy people = defence against hypoglycemia
What are the counterregulatory hormones in the context of diabetes?
Glucagon Epinephrine Norepinephrine Cortisol Growth hormone
What is the perioperative management needed for diabetic patients?
Book earlier in the day
Caution with pre-op sedation/narcotics in elderly DM patients - avoid hyper apnea/hypoxia
DC oral hypoglycemics 24 hr pre-op
Insulin dependent diabetics SHOULD NOT receive full dose of intermediate or long acting insulin on day of operation
- 1/3-1/2 NPH & reg no ring of surgery
- Start on D5W drip & monitor BG
Most effective management = omit intermediate and long-acting insulin altogether and use an insulin infusion 1-2U to start and titration to BG levels
What is a hyperosmolar coma?
Hyperglycaemia without ketosis because not enough insulin to prevent lipolysis
What is hyperosmolar coma characterized by?
Extreme hyperglycemia Increased osmolarity that may be >350 Severe dehydration Prerenal azotemia Mild acidosis Changes in mental status are common
What is the treatment for hyperosmolar coma?
Rehydrate - hypo-osmolar fluids
+/- Insulin - 10U reg test dose, then titration from there
Treat underlying cause
What is the management of DKA?
1L NS bonus, the 1L over 1 hr
10U regular insulin bonus then 0.1U/kg/hr IV maintenance
When BG,15 add 100cc/hr D10W with NS as rest of maintenance
Add KCl to IVF when K+ <5.4
Frequent bloodwork
