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 this group. 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 degree of replacement is not as much as previously thought.