- Anesthetic management of a patient with diabetes mellitus type 2
- Physiological changes due to diabetes mellitus
Definition and mechanisms
- Diabetes mellitus type 2 is a consequence of peripheral resistance to insulin action
- Is characterized by insulin resistance (hepatic, extrahepatic, or both) probably due to a decreased stimulation of glycogen synthesis in muscle by insulin, related to impaired glucose transport
- Insulin secretion and/or insulin action are thought to be deficient with excessive hepatic glucose production
- It is frequently associated with dysfunction in pancreatic β-cells responsible for insulin secretion
- The age of onset is variable, however, it is usually a disease of adults with slow onset
- Ketoacidosis is uncommon
|Musculoskeletal system||Stiff joint syndrome (SJS)|
|Neurological system||Increased risk of cerebrovascular accident (CVA)
Nerve fibers at risk for ischemic injury
|Autonomic neuropathy||Diabetic autonomic neuropathy
Impaired neurovascular function
Loss of autonomic response to Hypoglycemia
Coronary artery disease
Silent myocardial ischemia
Systolic and diastolic heart failure
Congestive heart failure
Peripheral vascular disease
Management of diabetes mellitus type 2
- Sulphonylureas (e.g. gliclazide)
- Biguanides (e.g. metformin)
- Thiazolidinediones (e.g. pioglitazone, rosiglitazone)
- Meglinitides (e.g. repaglinidine, nateglinide)
- Alpha-glucosidase inhibitors (e.g. acarbose, miglitol)
- Incretin mimetics:
- GLP-1 agonists (e.g. exanatide, liraglutide)
- DPP-4 inhibitors (e.g. sitagliptin and vildagliptin)
- SGLT2 inhibitors (e.g. canagliflozin, dapagliflozin, empagliflozin)
- Check blood glucose levels hourly until a normal diet is established
- Monitor plasma potassium 3-4 hourly, or more frequently if clinically indicated
- Administer appropriate analgesia
- Use NSAIDs with great caution as they may further impair renal function in patients with a nephropathy
- Avoid dexamethasone as it exacerbates insulin resistance
Keep in mind
HbA1c has a strong predictive value for complications of diabetes
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