PERI-OPERATIVE MANAGEMENT IN DIABETES MELLITUS

In diabetic patients, managing the glycemic levels in the perioperative period is challenging. Surgical stress and anesthesia have great impact on blood glucose levels, thus the healthcare professionals should be more cautious to maintain the optimal glycemic level. Almost 50% of diabetes patient undergoing surgery, has great chance of post-operative mortality when compared with normal glucose tolerant patient. In addition to this, there is 5 times greater risk of developing end organ damage and infections in uncontrolled diabetic patients. Hence, there is a need to optimize and improve the blood glycemic control before surgery. Tight glycemic control with intensive insulin therapy (IIT) has shown to reduce morbidity and mortality and improve the survival after the surgery. However, evidence suggest that severe hypoglycaemia and adverse outcomes with tight glycemic control brings its safety and efficacy into query. Hence, avoidance of hyperglycemia is clearly beneficial in the perioperative patients, although IIT continues to be standard of care, current consensus guidelines recommend less stringent glycemic goals, typically between 80-150mg|dl.