Perioperative management of diabetes mellitus and corticosteroid supplementation

It is increasingly common for diabetic patients to present for surgery; some patients requiring surgery will be taking glucocorticoids. This contribution discusses the perioperative management of both of these patient groups. Patients with diabetes require tight glycaemic control at the time of surgery because high blood glucose is associated with increased morbidity and mortality. There is increasing evidence that tight glycaemic control is also crucial in the care of critically ill patients. Strategies and protocols are described for the safe and effective management of blood glucose at the time of surgery. Patients taking corticosteroids require glucocorticoid replacement when undergoing surgery, although perhaps not to such an extent than was previously thought; a rational management strategy for these patients is also described.