Diabetes and Surgery

It has been estimated that: 
bullet50% of diabetic patients will have surgery and
bullet25% of these patients will have diabetes discovered perioperatively
bulletHistorically, Complications: In 17% of patients
33% wound infections
33% GU infections
4% delayed would healing
bulletInfections more common with emergency than elective procedures
bulletPatients with nephropathy predisposed to septic complications
 

 

Hormones Increased in Response to Surgical Stress


Epinephrine
Norepinephrine
Cortisol
Growth Hormone
Glucagon

 

 

Diabetes patients undergoing surgery have acute stress.  As shown above, in response to this stress, the counterregulatory hormones Epinephrine, Norepinephrine, Cortisol, Growth Hormone. Glucagon increase.  The metabolic changes that occur secondary to these hormonal surges are shown below on the left.  There is a net production of glucose, lipid and protein.  The unchecked potential consequence of these metabolic changes are shown below, with the high glucoses leading to fluid and electrolyte abnormalities and potential diabetic ketoacidosis and hyperosmolar coma.  The point of this course is to learn how to keep your patients from developing these problems.  In the GOALS SECTION, this will be fleshed out. 

 

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Metabolic Changes

Hyperglycemia

hyperosmolarity
glycosuria
lipolysis
proteolysis
glycogenolysis
increased gluconeogenesis
 

 

Clinical Results

 

dehydration
peripheral vascular insufficiency
electrolyte abnormalities
ketoacidosis
prerenal azotemia
lactic acidosis
hyperosmolar syndrome