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Special Surgical Situations in Diabetes: Part 2

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Towards Optimal Management of Diabetes in Surgery

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Abstract

Most frequently such a patient would usually be advanced in years, often with diabetes of long duration and likely to have obvious or ongoing complication of diabetes. There is poor tolerance of hypoglycemia in the elderly. The discussion that follows is relevant not only to the urological surgical patient but to all elderly patients in general. These points were not explained in greater detail earlier. The elderly Indian is not an active individual. Barring some morning walk which is on the increase in Indian cities despite the traffic congested and somewhat hazardous roads, they are sedentary individuals. Hence, exercise intolerance (either angina or dyspnea) may be difficult to assess clinically. It may not always be possible to put them to treadmill to detect exercise-induced angina. A relatively noninvasive procedure like 64-slice CT to detect coronary calcification degree is advisable if the patient is diagnosed to have symptoms of coronary artery disease.

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Notes

  1. 1.

    Dr. George Bakris speaking in the second International Diabetes Expert’s Conference in Pune, India, on 26th of May 2018 was highly critical of the trials which demanded such low blood pressures (as well as tight control in the elderly) since the mortality in these trials was unacceptable.

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  1. Private Practice, Pune, Maharashtra, India

    Sanjeev Kelkar

  2. Senior Consultant Anesthesiologist, Central India Institute of Medical Science, Nagpur, Maharashtra, India

    Shubhangi Muley

  3. Consultant, Anesthesioligist, Fortis S L Raheja Hospital, Mumbai, Maharashtra, India

    Prakash Ambardekar

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Kelkar, S., Muley, S., Ambardekar, P. (2019). Special Surgical Situations in Diabetes: Part 2. In: Towards Optimal Management of Diabetes in Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-7705-1_8

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