Management of the diabetic patient in elective surgery

Patients with diabetes mellitus are subjected to major operations, and to major complications, more frequently than those without diabetes. Diabetes control is especially important when the patient is undergoing surgery, as the trauma can result in major metabolic changes; in fact, maintaining glycemic and metabolic control is difficult in diabetic patients who are undergoing surgery. In planning the management, the type of diabetes, the current treatment, the degree of recent control, the presence of complication, and the type of surgical procedure must all be considered. The authors reported their therapeutic protocol for the management of the diabetic patients in the perioperative period, and for the complication (ketoacidosis, hyperosmolar nonketotic coma). The preparation of the diabetic patient must start, if is possible, 6 months before the operation, to reduce the possible complications after the surgical stress. To this aim, we utilize a nursing-monitoring sheet, that allows a direct comparison of laboratory tests (glicemic levels, electrolytes, urine glucose testing, ketonuria, glycohemoglobin level, hemogasanalysis, etc.), clinical status (weight, diuresis, etc.) of the patient, and the therapy (dose and times of administration).