Management of the diabetic surgical patient. A systematic but flexible plan is the key.

Diabetes control is especially important when the patient is undergoing surgery, as the trauma can result in major metabolic changes. Complications of diabetes must be assessed preoperatively, since they themselves can lead to the need for surgery or can predispose to increased surgical or anesthetic risk. The preoperative blood glucose status of diabetics can be assessed by use of standard laboratory methods, self monitoring devices, urine glucose testing, or measurement of glycohemoglobin level. Blood glucose control can be maximized by designation of one physician on the health care team to be in charge of fluid, electrolyte, and insulin administration on perioperative days. This physician should follow a definite protocol of subcutaneous insulin administration guided by appropriate monitoring of blood glucose response. In special cases, such as surgery in the pregnant diabetic, a more complex scheme of management using low-dose insulin infusion may be required. Coexistence of another endocrine disease with diabetes should be recognized, since it may lead to otherwise unexpected changes in insulin requirements. A systematic and comprehensive yet flexible approach to the treatment of diabetes before, during, and after surgery puts a successful outcome well within the reach of the modern clinician.