Perioperative management of diabetes mellitus and corticosteroid insufficiency

The prevalence of diabetes is increasing and is becoming a larger part of the workload for healthcare professionals. Surgery causes a stress response which in turn causes hyperglycaemia. Perioperative hyperglycaemia is associated with a high incidence of surgical complications. There is increasing evidence that tighter glycaemic control is important in reducing complications. Strategies and suggested protocols for the safe and effective management of Type 1 and Type 2 diabetic patients are discussed.Patients on corticosteroids for co-existing medical conditions and patients undergoing surgery for hypercortisolism may be unable to mount an effective steroid response to surgical stress and need perioperative supplementation. A management strategy for this group is also described as the required extent of steroid replacement is not as high as previously thought.