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Diabetes Mellitus Listen to Audio clinical manifestations diagnosis treatment potential acute complications potential chronic complications Clinical manifestations: -polyuria -polydipsia -polyphagia Diagnosis: -hyperglycemia -glycosuria -fasting plasma glucose > 140 mg/dL -blood glucose > 126 mg/dL Treatment: -insulin sliding scale Potential acute complications: -diabetic ketoacidosis (DKA) -hyperosmolar nonketotic coma -hyperglycemia ex. DKA Increased free fatty acids leads to ketone bodies which further increase: -acetoacetate -beta-hydroxybutyrate -increased weak organic acids leads to increased anion gap acidosis Clinical manifestation of DKA: -dyspnea: hyperventilation in order to compensate for metabolic acidosis -abdominal pain -nausea and vomiting -change in mental status Treatment of DKA: -correct fluid deficit with NS 1-2 L the 1st hour then NS 200 - 500/hr -decreased blood glucose to 75-100mg/dL/hr -give regular insulin 10U/hr or 0.1U/kg/hr then double the dose q hr until blood glucose begins to decline -once [glucose] = 250 mg/dL then give D5W + insulin infusion -correct [K+] Potential chronic complications -myocardial ischemia/infarction -peripheral vascular disease -hypertension -cerebral vascular disease -autonomic neuropathy -renal failure preoperative management Evaluate for presence/absence of organ dysfunction: -cns: excitatory,confusion, coma -airway: TMJ instabilty -cvs: cardiac enlargement,ST segment abnormalities, T wave abnormality -resp: increased pulmonary vascular congestion,pleural effusion -GI: gastroparesis, increasing the risk of gastric aspiration recommended a.m. insulin dose -recommended to provide 1/2 usual am "total" insulin dose -given in the form of intermediate acting insulin Intraoperative management: -avoid hyperglycemia: > 180 mg/dL -maintain euglycemia: 120 - 180 mg/dL -avoid hypoglycemia: < 50 mg/dL -follow insulin sliding scale

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