Perioperative management of ambulatory surgical patients with diabetes mellitus.
OBJECTIVE
Patients with diabetes frequently present for ambulatory surgery concomitant with the rise in incidence of the disease. This review will examine recent evidence on glucose control, the harmful effects of hyperglycemia, fluctuations of blood glucose, and hypoglycemia, as well as treatments and medications utilized for type 1 and type 2 diabetes mellitus. Based on this evidence, a strategy for perioperative decision making for the diabetic patient undergoing ambulatory surgery will be presented.


RESULTS
New studies question the practice of intensive control of blood glucose in critically ill patients. Also, tight control of HbA1c levels in patients with type 2 diabetes may have associated cardiovascular risks. Glucose fluctuations and hypoglycemia may pose greater risks to patients than elevated glucose itself. New medications and insulin regimens make perioperative blood glucose control easier now than in the past.


CONCLUSIONS
The ambulatory anesthesiologist, with a dedication to low-impact practices and emphasis on rapid recovery, provides an ideal environment of care for the patient with diabetes. This review will examine issues and concerns with management of the patient with diabetes undergoing ambulatory surgery and address them in a step-wise strategy for care, including recommendations for perioperative insulin administration.
Vann
Mary Ann
MA
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. mvann@bidmc.harvard.edu
D000556:Ambulatory Surgical Procedures; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007430:Intraoperative Care; D019990:Perioperative Care
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin