Anaesthetic management of the patient with diabetes

Diabetes mellitus is the most common endocrine disorder. Type 1 diabetes is caused by an immune-mediated destruction of insulin-secreting islet cells. Type 2 is due to insulin resistance. The prevalence is expected to double by 2030 in the UK. Patients with both types of diabetes demand control of their metabolic status, normoglycaemia, the avoidance of ketoacidosis and electrolyte disturbances. The consequences of long-term diabetes – cardiovascular diseases, autonomic and peripheral neuropathy, stiff joint syndrome and renal insufficiency as well as the associations of type 2 diabetes of obesity and lack of exercise – demand understanding and skill from the anaesthetist. A good preoperative evaluation of long-term effects such as coronary heart disease, hypertension and renal insufficiency plus the risk of difficult intubation and pulmonary aspiration are of major importance. The aim is perioperative homeostasis of electrolytes and blood glucose as well as the maintenance of normovolaemia and maximal reduction of perioperative stress. Sufficient postoperative pain relief and prevention of nausea and vomiting ensure early enteral feeding. The avoidance of infection with calculated antibiotic therapy, early mobilization and physiotherapy are essential. Minor surgery can often be performed as a day case. This demands adequate care at home and motivation and compliance of the patient. Day case centres should implement guidelines for the treatment of patients with diabetes, and strictly comply with them. There is no evidence that anaesthetic technique influences morbidity or mortality in patients with diabetes.