Diabetes Mellitus

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clinical manifestations
diagnosis
treatment
potential acute complications
potential chronic complications

Clinical manifestations:

-polyuria
-polydipsia
-polyphagia

Diagnosis:

-hyperglycemia
-glycosuria
-fasting plasma glucose > 140 mg/dL
-blood glucose > 126 mg/dL

Treatment:

-insulin sliding scale

Potential acute complications:

-diabetic ketoacidosis (DKA)
-hyperosmolar nonketotic coma
-hyperglycemia
ex. DKA

Increased free fatty acids leads to ketone bodies which further increase:
-acetoacetate
-beta-hydroxybutyrate
-increased weak organic acids leads to increased anion gap acidosis

Clinical manifestation of DKA:

-dyspnea: hyperventilation in order to compensate for metabolic acidosis
-abdominal pain
-nausea and vomiting
-change in mental status

Treatment of DKA:

-correct fluid deficit with NS 1-2 L the 1st hour then NS 200 - 500/hr
-decreased blood glucose to 75-100mg/dL/hr
-give regular insulin 10U/hr or 0.1U/kg/hr then double the dose q hr until blood glucose begins to decline
-once [glucose] = 250 mg/dL then give D5W + insulin infusion
-correct [K+]

Potential chronic complications

-myocardial ischemia/infarction
-peripheral vascular disease
-hypertension
-cerebral vascular disease
-autonomic neuropathy
-renal failure

preoperative management

Evaluate for presence/absence of organ dysfunction:

-cns: excitatory,confusion, coma
-airway: TMJ instabilty
-cvs: cardiac enlargement,ST segment abnormalities, T wave abnormality
-resp: increased pulmonary vascular congestion,pleural effusion
-GI: gastroparesis, increasing the risk of gastric aspiration
recommended a.m. insulin dose
-recommended to provide 1/2 usual am "total" insulin dose
-given in the form of intermediate acting insulin

Intraoperative management:

-avoid hyperglycemia: > 180 mg/dL
-maintain euglycemia: 120 - 180 mg/dL
-avoid hypoglycemia: < 50 mg/dL
-follow insulin sliding scale