What strategies can healthcare providers employ to maintain optimal glucose control in diabetic patients undergoing surgery?Article The Impact of Hyperglycemia on Perioperative Outcomes in Pat...
Indunil Karunarathna
Preoperative Assessment and Optimization: Before surgery, conduct a thorough assessment of the patient's diabetes management, including glycemic control, medication regimen, and comorbidities. Optimize glucose control through adjustments in diet, exercise, and medication regimen if needed. Ensure that any underlying medical conditions that may affect glucose metabolism are addressed prior to surgery. Multidisciplinary Approach: Implement a multidisciplinary approach involving endocrinologists, surgeons, anesthesiologists, and nursing staff to coordinate perioperative diabetes management. Collaborate closely with the patient's primary care physician or endocrinologist to develop an individualized perioperative glycemic management plan. Preoperative Glycemic Control: Aim for tight glycemic control in the perioperative period to reduce the risk of hyperglycemia-associated complications. Consider initiating insulin therapy or adjusting oral hypoglycemic agents to achieve target blood glucose levels (typically 80-180 mg/dL or 4.4-10 mmol/L) before surgery. Monitor blood glucose levels closely in the preoperative period. Intraoperative Glucose Monitoring: Implement continuous glucose monitoring (CGM) or frequent point-of-care glucose testing during surgery to monitor blood glucose levels closely. Adjust insulin infusion rates or administer supplemental glucose as needed to maintain euglycemia throughout the procedure. Individualized Insulin Therapy: Tailor insulin therapy to the patient's specific needs based on factors such as insulin sensitivity, anticipated duration of fasting, and surgical stress. Consider using basal-bolus insulin regimens, insulin infusions, or sliding-scale insulin protocols to maintain glucose control perioperatively. Avoidance of Hypoglycemia: Prevent hypoglycemia by carefully titrating insulin doses and avoiding prolonged fasting periods without glucose supplementation. Monitor for signs and symptoms of hypoglycemia and intervene promptly with oral glucose or intravenous dextrose if necessary. Postoperative Glycemic Control: Continuously monitor blood glucose levels in the postoperative period and initiate insulin therapy as needed to maintain euglycemia. Consider resuming the patient's regular diabetes medications once oral intake is resumed and the patient's clinical condition permits. Nutritional Support: Provide adequate nutritional support to meet the patient's energy and glucose requirements perioperatively. Consider early enteral or parenteral nutrition in patients who are unable to tolerate oral intake to prevent malnutrition and stabilize blood glucose levels. Patient Education and Empowerment: Educate patients about the importance of glycemic control during the perioperative period and empower them to actively participate in their diabetes management. Provide guidance on self-monitoring of blood glucose, medication administration, and recognition of hyperglycemia and hypoglycemia symptoms.
Article The Impact of Hyperglycemia on Perioperative Outcomes in Pat...
Maintaining optimal glucose control in diabetic patients undergoing surgery is crucial for reducing the risk of perioperative complications and improving surgical outcomes. Healthcare providers can employ several strategies to achieve this goal:
By implementing these strategies, healthcare providers can optimize glucose control in diabetic patients undergoing surgery, minimize the risk of perioperative complications, and improve overall surgical outcomes.
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