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Principles of Care in the Diabetic Surgical Patient

  • Natasha Khazai
  • Osama Hamdy
Chapter
First Online:
Part of the Contemporary Diabetes book series (CDI)

Abstract

Currently, around 29 million or 11% of US adults have diabetes and 86 million are thought to have prediabetes. The healthcare spending on diabetes is soaring with an estimate of $250 billion, of which 43% are spent in hospital care to treat diabetes and its complications. Patients with diabetes are frequently admitted to the hospital for surgical interventions. Common surgical reasons in relation to diabetes include diabetic foot problems, vascular surgeries, coronary artery bypass, kidney transplant, and eye surgeries. Meanwhile, patients with diabetes are frequently admitted for any other surgical interventions unrelated to diabetes. During admission, diabetes management may vary based on the location of patient whether in surgical intensive care units or in regular wards. It also varies based on nutrition whether it is regular oral feeding, enteral tube feeding, parental feeding, or just clear intravenous fluids. Good diabetes control shortens length of hospital stay, reduces complications, and reduces hospital mortality and hospital 30- and 90-day readmission rate. While oral medications and/or insulin are commonly used to treat diabetes in outpatient setting, only insulin is recommended for treating diabetes during surgical admission. Insulin method of administration, insulin type, and dose vary significantly between patients. Use of steroids may complicate insulin regimen. Patients on insulin infusion pump also require specific consideration. The major risk of insulin use is hypoglycemia, which is infrequently severe. This chapter comprehensively covers the principals of diabetes management during hospital admission.

Keywords

Type 1 diabetes Type 2 diabetes Inpatient Insulin Insulin infusion Basal Bolus Prandial Correction factor Correction dose Insulin pump Enteral nutrition Parental nutrition Hypoglycemia 
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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Joslin Diabetes CenterBostonUSA

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