Advertisement

Role of Residents and Nurses in Perioperative Diabetes Management

  • Sanjeev Kelkar
  • Shubhangi Muley
  • Prakash Ambardekar
Chapter

Abstract

Managing diabetes optimally in emergency or routine surgery is still a gray area. In patients who are critically ill, it is much more complex. Optimal control within limitations of surgical setting is rarely achieved in most places. Excessive or too frequent monitoring without dynamically changing plans for controlling the blood glucose to its optimal level is common. Optimal/tight blood glucose control leads to far better outcomes in all types of surgical settings [1]. The primary reason for not undertaking aggressive management is the illogical fear of hypoglycemia and its consequences. The second is the inability to understand the relation between hyperglycemia in surgical setting and the causes leading to it. This in its turn leads to further indecisiveness about continuously altering the insulin administration to the dynamically changing causes. The third is the lack of knowledge of the pharmacokinetics and pharmacodynamics of administered insulin. Fourth is the high levels of insulin resistance that is obtained in these situations and how to break the resistance to achieve normoglycemia. Insulin resistance increases by seven- to eightfold in patients undergoing surgical procedures [2]. All of these factors with many more lead to a state of continuous hyperglycemia.

References

  1. 1.
    Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRefGoogle Scholar
  2. 2.
    Ljungqvist O, Jonathan E. Rhoads lecture 2011: insulin resistance and enhanced recovery after surgery. J Parenter Enter Nutr. 2012;36(4):389–98.CrossRefGoogle Scholar
  3. 3.
    Böhme P, Floriot M, Sirveaux M-A, Durain D, Ziegler O, Drouin P, Guerci B. Evolution of analytical performance in portable glucose meters in the last decade (1989 to 1990). Diabetes Care. 2003;26:1170–5.CrossRefGoogle Scholar
  4. 4.
    National Diabetes Service Scheme. Use of blood glucose meters March 2015, Diabetes Australia.Google Scholar
  5. 5.
    Van den Berghe GH. Role of intravenous insulin therapy in critically ill patients. Endocr Pract. 2004;10(Suppl. 2):17–20.CrossRefGoogle Scholar
  6. 6.
    Roche. user_manual_active_infinity, by Accu Check.Google Scholar
  7. 7.
    Rice MJ, Pitkin AD, Coursin DB. Glucose measurement in the operating room: more complicated than it seems. Anesth Analg. 2010;110(4):1056–65.PubMedGoogle Scholar
  8. 8.
    Mraovic B, Schwenk ES, Epstein RH. Intraoperative accuracy of a point-of-care glucose meter comparedwith simultaneous central laboratory measurements. J Diabet Sci Technol. 2012;6(3):541–6.CrossRefGoogle Scholar
  9. 9.
    Alberti KGMM, Gill GV, Elliott MJ. Insulin delivery during surgery in the diabetic patient. Diabetes Care. 1982;5(1):65–77.PubMedGoogle Scholar
  10. 10.
    Kelkar SK. CIIMS bulletin, 1994.Google Scholar
  11. 11.
    Gavin LA. Perioperative management of the diabetic patient. Endocrinol Metab Clin N Am. 1992;21(2):457–75.CrossRefGoogle Scholar
  12. 12.
    Hirsch IB, McGill JB. Role of insulin in management of surgical patients with diabetes mellitus. Diabetes Care. 1990;13(9):980–91.CrossRefGoogle Scholar
  13. 13.
    Reynolds C. Management of the diabetic surgical patient. A systematic but flexible plan is the key. Postgrad Med. 1985;77(1):265–79.CrossRefGoogle Scholar
  14. 14.
    Peters A, Kerner W. Perioperative management of the diabetic patient. Exp Clin Endocrinol Diabet. 1995;103(4):213–8.CrossRefGoogle Scholar
  15. 15.
    Fetchick DA, Fischer JS. Perioperative management of the patient with diabetes mellitus undergoing outpatient or elective surgery. Clin Podiatr Med Surg. 1987;4(2):439–43.PubMedGoogle Scholar
  16. 16.
    Smail PJ. Children with diabetes who need surgery. Arch Dis Child. 1986;61(4):413–4.CrossRefGoogle Scholar
  17. 17.
    Marks JB. Perioperative management of diabetes. Am Fam Phys. 2003;67(1):93–100.Google Scholar
  18. 18.
    Gill GV, Alberti KGMM. The care of the diabetic patient during surgery. In: Edwards CMB, editor. International textbook of diabetes mellitus, vol. 2004. New York, NY: John Wiley & Sons.Google Scholar

Additional Reading

  1. Böhme P, Floriot M, Sirveaux M-A, Durain D, Ziegler O, Drouin P, Guerci B. Evolution of analytical performance in portable glucose meters in the last decade (1989 to 1990). Diabetes Care. 2003;26:1170–5.CrossRefGoogle Scholar
  2. Ginsberg BH. Factors affecting blood glucose monitoring: sources of errors in measurement. J Diabet Sci Technol. 2009;3(4):903–13. © Diabetes Technology Society.CrossRefGoogle Scholar
  3. Goldberg PA, Inzucchi SE. Selling root canals: lessons learned from implementing a hospital insulin infusion protocol. Diabetes Spectr. 2005;18(1):28–33.CrossRefGoogle Scholar
  4. National Diabetes Service Scheme. Use of blood glucose meters March 2015, Diabetes Australia.Google Scholar
  5. Roche. user_manual_active_infinity, by Accu Check.Google Scholar
  6. Sudhakaran S, Surani SR. Guidelines for perioperative management of the diabetic patient. Review article. Surg Res Pract. 2015;2015:Article ID 284063.  https://doi.org/10.1155/2015/284063.CrossRefGoogle Scholar
  7. Van den Berghe GH. Role of intravenous insulin therapy in critically ill patients. Endocr Pract. 2004;10(Suppl. 2):17–20.CrossRefGoogle Scholar
  8. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Sanjeev Kelkar
    • 1
  • Shubhangi Muley
    • 2
  • Prakash Ambardekar
    • 3
  1. 1.Private PracticePuneIndia
  2. 2.Senior Consultant AnesthesiologistCentral India Institute of Medical ScienceNagpurIndia
  3. 3.Consultant, AnesthesioligistFortis S L Raheja HospitalMumbaiIndia

Personalised recommendations