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Contents

Introduction

Metabolic Consequences of Surgery in Type 1 Diabetes Evaluation of Patients with Type 1 Diabetes Prior to Surgery

Management of Patients with Type 1 Diabetes

During Surgery Management of Patients with Type 1 Diabetes During

Emergency Surgery Conclusion References

Advances in the treatment of type 1 diabetes (T1DM) have allowed people with this disease to live longer. Aggressive treatment of complications and the widespread use of renal transplantation and coronary artery bypass grafting have substantially improved quality of life. Consequently, the number of people with T1DM who require elective and emergency surgery has increased.

Surgery and anesthesia affect glucose homeostasis in a variety of ways. Surgery leads to catabolism with hyperglycemia, a decrease in insulin action, and an increased risk of ketoacidosis. It is associated with an increased risk of infection and a period of starvation. The effects of these processes on glucose concentration can be dramatic if not compensated for by an increase in insulin secretion, as is indeed the case in T1DM.

Management of the surgical patient with T1DM is therefore complex and needs to take into account the nature and severity of the surgical intervention, as well as the presence of diabetic complications or other concurrent illnesses present in the patient undergoing the procedure. Preoperative stabilization of glucose concentrations is ideal but is not possible in emergency surgery and is becoming less practical in an environment of cost containment with increasing emphasis on shorter hospital stays.

Therefore, the goals of perioperative management of a person with T1DM is to minimize the risk of ketoacidosis, severe hyperglycemia, or hypoglycemia as well as to facilitate wound healing without prolonging hospitalization.

From: Contemporary Endocrinology: Type 1 Diabetes: Etiology and Treatment Edited by: M. A. Sperling © Humana Press Inc., Totowa, NJ

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