Anaesthetic management of the diabetic patient

Diabetes mellitus is the most common endocrine disorder and its incidence is increasing dramatically. It affects many body systems including the cardiovascular, renal, neurological and ophthalmic systems. About 50% of diabetic patients will need surgical intervention and therefore the anaesthetist must understand the disease process, treatment and operative management. The anaesthetist should also be aware of the systemic signs and symptoms associated with the multisystem nature of diabetes and of their significance regarding administration of an anaesthetic. Diabetes is split into five diagnostic groups, of which the most common are type 1 and type 2. Anaesthetists will also encounter gestational diabetics in the labour suite. The perioperative management depends on the type of diabetes and the degree of surgery (minor or major). The key points of anaesthetic management are to avoid hypoglycaemia (and its possible fatal consequences), avoid swings in blood sugar, avoid dehydration, avoid hypokalaemia and prevent ketoacidosis. The practicalities of the anaesthetic management include simple measures such as the placement of patients first on operating lists, using regional techniques where possible, using glucose/insulin supplementation perioperatively, regular blood glucose monitoring, and careful asepsis for all invasive procedures. The anaesthetist will also be expected to provide advice on postoperative fluids and insulin supplementation until the patients are eating and back on their regular insulin regimen.