Diabetes and Anaesthesia

Question 1

What is type 1 diabetes?

Answer 1

-inability to produce insulin because of the destroyed beta cells in the pancreas

Question 2

What is type 2 diabetes?

Answer 2

-produces insulin but there is insulin resistance

There’s more glucose released from the liver than is being uptakes by the tissues

Question 3

What is gestational diabetes?

Answer 3

-develops during pregnancy because of rather metabolic load

Question 4

What tests do we do ton diagnose diabetes?

Answer 4

1. Random: >11,1 mmol/l
2. Fasting: >7 mmol/l
3. HbA1C>6,5%

Question 5

What is the differential diagnosis for hyperglycaemia?

Answer 5

1. Pancreatic disease
2. Metabolic syndrome
3. Endocrinopathies
4. Drugs-glucosteroids
5. Genetic disorders

Question 6

What should we worry about a couple of days post-operatively?

Answer 6

-sudden death because of a silent myocardial infarction or myocardial ischaemia which can cause hypotension, dysarrthmias, ECG changes peri-operatively

Question 7

What reduces the risk of peri-operative myocardial infarction?

Answer 7

-beta adrenergic blockers

Question 8

Which drugs do we usually use to control the hypertension in diabetic patients peri-operatively?

Answer 8

ACE inhibitors

Question 9

What is stiff joint syndrome?

Answer 9

• happens to longstanding type 1 diabetic patients

- they have stiff joints particularly of the airway and this causes difficult intubation

Question 10

Which drugs should be avoided if the patient has renal impairment?

Answer 10

Metformin

Question 11

What aspiration prophylaxis can we give to patients?

Answer 11

Metoclopramide

Question 12

List 5 signs and symptoms of autonomic neuropathy in diabetic patient?

Answer 12

1. Decreased heart rate variability with vasalva, respiration or change in position
2. Orthostatic hypertension
3. Resting tachycardia
4. impotence
5. Gastro-intestinal dysmotility

Question 13

What is orthostatic hypertension?

Answer 13

-increase of systolic blood pressure of about 20mmHg and diastolic blood pressure of 10mmHg when moving from supine to upright

Question 14

What are the main things to focus on pre-operatively?

Answer 14

1. History and examination

- ask about the type of diabetes, medication, duration of the disease, how well controlled,

Question 15

Why must you focus special attention on the airway and neck structures?

Answer 15

• to figure out whether intubation will be easy or not

- test the hoarseness, voice changes and prayer sign

Question 16

How do we test the autonomic neuropathy?

Answer 16

Ask the patient to do the vasalva makeover and check the heart rate

Question 17

What other organs can we test for pre-operatively that we could be worried about?

Answer 17

1. Renal system-do urinalysis, blood urea and creatinine to test for renal disease
2. ECG-check for poor RR variability

Question 18

What is the normal value of HBA1C in non diabetics?

Answer 18

-5-7% is normal

Question 19

Before surgery what glucose value should we aim for?

Answer 19

4-8mmol/l

Question 20

Which class of drugs can give rise to lactate accumulation and acidosis?

Answer 20

Biguanides

Question 21

What should we prevent happening intra-op in a patient?

Answer 21

-hyperglycaemia caused by pain and the release of cortisol and adrenaline

Question 22

What is one disadvantage of general anaesthesia use in a diabetic patient?

Answer 22

The symptoms of hypoglycemia are diminished

Question 23

How often should we check the blood glucose in these patients intra-operativelky?

Answer 23

-every 30 minutes and should be controlled to 6-8mmol/l

Question 24

If the patients blood glucose drops to less than 6mmol/l what can we do?

Answer 24

Give dextrose containing fluids as boluses or maintenance

Question 25

Why do diabetic patients experience wound infections more easily?

Answer 25

-the postulation that high levels of glucose causes white blood cell Che oat is and function

Question 26

What should we ensure happens post-operatively?

Answer 26

1. Analgesia
2. Early enteral feeding
3. Strict fluid management
4. Make sure patient starts oral medication once oral feeding happens