Perioperative management of diabetes: Translating evidence into practice

Luigi F. Meneghini

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Glycemic control before, during, and after surgery reduces the risk of infectious complications; in critically ill surgical patients, intensive glycemic control may reduce mortality as well. The preoperative assessment is important in determining risk status and determining optimal management to avoid clinically significant hyper- or hypoglycemia. While patients with type 1 diabetes should receive insulin replacement at all times, regardless of nutritional status, those with type 2 diabetes may need to stop oral medi cations prior to surgery and might require insulin therapy to maintain blood glucose control. The glycemic target in the perioperative period needs to be clearly communicated so that proper insulin replacement, consisting of basal (long-acting), prandial (rapid-acting), and supplemental (rapid-acting) insulin can be implemented for optimal glycemic control. The postoperative transition to subcutaneous insulin, if needed, can begin 12 to 24 hours before discontinuing intravenous insulin, by reinitiation of basal insulin replacement. Basal/bolus insulin regimens are safer and more effective in hospitalized patients than supplemental-scale regular insulin.

Original languageEnglish
JournalCleveland Clinic Journal of Medicine
Volume76
Issue numberSUPPL. 4
DOIs
StatePublished - Nov 1 2009

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Insulin
Short-Acting Insulin
Perioperative Period
Nutritional Status
Type 1 Diabetes Mellitus
Hypoglycemia
Critical Illness
Hyperglycemia
Type 2 Diabetes Mellitus
Meals
Blood Glucose
Cations
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Perioperative management of diabetes : Translating evidence into practice. / Meneghini, Luigi F.

In: Cleveland Clinic Journal of Medicine, Vol. 76, No. SUPPL. 4, 01.11.2009.

Research output: Contribution to journalArticle

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