Diabetes Mellitus Flashcards
What is considered ideal (target) glucose control?
A1C <7%
Study:
An intact sympathetic nervous system can be assessed by the following: A normal response in diastolic pressure (from lying to standing) is a change of at least 16 mm Hg; an affected patient has a response of <10 mm Hg. Autonomic neuropathy is also evidenced by a large change in systolic blood pressure when changing from lying to standing posture. A normal decrease is <10 mm Hg; an affected patient has a decrease
of at least 30 mm Hg.
Study:
An intact parasympathetic nervous system can be assessed by observing heart rate
response to breathing. Normal patients increase heart rate by at least 15 beats/min. Affected patients have an increase of 10 or fewer beats/min. Finally, concurrent with electrocardiogram (ECG) monitoring, the R-R ratio can be measured during a Valsalva maneuver. A normal ratio is >1.2; an abnormal response is <1.1.
What is an early manifestation of diabetic nephropathy?
Proteinuria
Are there any signs that oral intubation may be difficult?
Stiff joint syndrome or prayer sign
The patient cannot touch the palmar aspects of the
fingers together when the palms are together
Glucose goal intraoperatively
120 to 180 mg/dL
How fast can the blood glucose be lowered in a markedly hyperglycemic patient?
Not lower than 100 mg/dL/hr
rapid drop in blood glucose could lead to cerebral
Swelling and in rare cases to symptomatic cerebral edema
How many hours to continue insulin infusion?
May continue for 48 hours
If the stress of a long surgery raises glucose levels, the basal infusion rate can be safely raised in increments of?
0.1 unit/hour
Describe the management of patients with diabetes requiring urgent surgery.
1) Rehydration (10-20 mL/kg)
2) Infuse insulin at 0.1 unit/kg/hr using 0.45 NS (or D10 in 0.45 NS if glucose is <150 mg/dl)
