New insulin analogues and insulin delivery devices for the perioperative management of diabetic patients.
OBJECTIVE
With the rising incidence of diabetes mellitus in the United States today, more and more patients with this comorbidity will present for surgical or interventional procedures. Treatments are becoming more varied and complex so anesthesiologists must be familiar with new drugs and delivery modalities used in the treatment of this patient population.


RESULTS
New types of insulin have revolutionized diabetic care. The introduction of rapid acting and long acting insulin has enabled more precise glucose control to be achieved. New delivery modes of insulin both by the inhaled/buccal route and premeasured pen have been introduced. The newer oral hypoglycemic agents are also in use and have mechanisms of action that differ from the older treatments.


CONCLUSIONS
Anesthesiologists must keep themselves updated with the rapidly changing treatment options for diabetic patients with both type 1 and type 2 diseases. The mechanism of action and duration of newer drugs are important for clinicians to know when managing intraoperative serum glucose control.
Ferrari
Lynne R
LR
Perioperative Services, Children's Hospital, Boston, Massachusetts 02115, USA. lynne.ferrari@childrens.harvard.edu
D000758:Anesthesia / Q000379:methods* / Q000592:standards; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D019990:Perioperative Care
D007004:Hypoglycemic Agents; D007328:Insulin