Management of diabetes around emergency and elective procedures

摘要

Question: A 30-year-old patient with type 1 diabetes is listed for minor surgery. The ward doctor wants to commence the patient on an intravenous insulin 'sliding scale' to cover the patient while fasting, Is this really necessary? The presence of diabetes as a co-morbidity to any admission is known significantly to increase length of stay and to increase peri-operative mortality. The reasons for this may include other co-morbidities but they are also influenced by control of blood glucose and the misuse of medication, par-ticularly insulin. The 2009 National Diabetes Inpatient Audit found that a quarter of patients on surgical wards experienced a hypoglycaemic event, potentially influencing mortality. Conversely, high blood glucoses may affect wound healing and increase post-operative infections.