Surgical Complications of DM Flashcards
What happens to BG levels with hospitalization or inflammation?
Cortisol levels increase, causing insulin resistance
Can DM be reversed by diet?
Yes
What percent of calories should be plant based? What is the actual amount obtained?
80%
12%
What is the major difference between ED visits and office visits for DM?
Office visits allow for more time for evaluation
Why is the CV exam so important with DM pts?
the biggest comorbidity
What is the best question to ask patients to assess mobility/functional status?
Can you walk around the block?
What is the MOA of clopidogrel?
ADP inhibitor
Over what age is a cardiac risk factor?
70 yo
What rhythms are a risk criteria for an MI?
Anything other than NSR
What are the three major things to do to workup DM emergently preoperatively?
- Baseline vitals
- EKG
- Blood work
What are the four major postoperative issues with DM?
- Infections
- Wound care
- Glucose control
- Gastroparesis
What are the two major factors that increase infection susceptibility with DM pts?
- Reduced vascular perfusion
- Increased glucose for pathogens
What is the effect of hyperglycemia on the complement cascade?
Inhibition
What is the relation between sternal infections and hyperglycemia?
Sugars over 200 mg/dL increased the incidence of sternal wound infections
What is the error rate of accuchecks?
10%
What is the effect of intensive insulin therapy post op?
Increased mortality
What is the BG level that is the goal of post op DM pts?
Less than 180 mg/dL
True or false: you usually stop oral DM II drugs prior to surgery?
True
What is the major complication of metformin?
Lactic acidosis
What are the major side effects of first and second generation sulfonylureas?
Hypoglycemia for both
Disulfiram effect in 1st gen
What are the diseases that can prevent absorption of insulin SQ?
sepsis
IVFs
What happens to peripheral circulation with sepsis (not shock)?
Vasoconstriction
What is the danger of administering SQ and IV insulin?
IV will work now, and SQ can work later when perfusion increases. This is a risk for hypoglycemia
What is the major GI effect of DM? What is the effect of this with intubation?
- Gastroparesis
- Increased risk of aspiration
What is the MOA of metoclopramide?
D2 receptor antagonist
also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist.
What are the complications that can arise from post op MI with DM?
PEs
Arrhythmias
What is the consequence of fatter liver?
- Decreased metabolism of drugs, even following operation
- Increased risk of cirrhosis
What is the effect of DM on contrast-induced nephropathy? How do you prevent this?
High risk
Hydrate and give N-acetylcysteine
What is the MOA of N-acetylcysteine?
Glutathione donor to protect liver from free radical damage
What is Fournier’s gangrene?
A horrendous infection of the genitalia that causes severe pain in the genital area and progresses from erythema to necrosis of tissue. Gangrene can occur within hours.
What is the treatment for Fournier’s gangrene?
Need emergent surgical debridement–abx will not suffice
What are the meds that can worsen hyperglycemia in the hospital?
Steroids
TPN
What is the effect of DM on the administration of local anesthesia?
May not need anything, or will need to alter dose to prevent nerve damage
What should you do if a DM pt has a BG level less than 70 mg/dL prior to a surgery?
Give 100-200 ccs of D5 or D10
What should you do if a DM pt has a BG level greater than 250?
Give SQ insulin
What should you do if a DM pt has a BG level greater than 70-250?
Give regular IVF
What are the inflammatory processes that are downregulated with hyperglycemia? (4)
- Less rolling/adherence
- Phagocytosis
- Macrophage activation
- Complement cascade
