Anesthesia Considerations 

Diabetes Mellitus

 

 

 

Considerations

 

• Potential difficult airway (↓TMJ mobility, obesity)

• Aspiration risk with gastroparesis 

• End organ disease:

  • Hypertension, coronary artery disease, left ventricular hypertrophy & cardiomyopathy

  • Peripheral vascular disease 

  • Chronic kidney disease 

  • Neuropathy 

    • Autonomic instability

    • Chronic pain

• Perioperative complications & management of blood glucose & medications: 

  • Related to severity of disease & control of blood glucose (hypoglycemia)

  • DKA or HONK

  • Hypoglycemia

  • Related to end organ disease

 

Goals

 

• Evaluate severity of end organ dysfunction

• Perioperative management of elevated blood glucose: Canadian Diabetes Association guidelines suggests 5-10 mmol/L

  • If only on PO hypoglycemics at home: start IV insulin infusion at 1-2 units/hr

  • If on insulin at home, divide 24 hr dose by 24 & give 1/2 to 2/3 that per hour as an IV insulin infusion

  • Consider bolusing a few units up front

• Preoperatively (see SAMBA guidelines below): 

  • Type II diabetes, diet controlled: fast, check blood glucose

  • Type II diabetes, on oral hypoglycemics: fast, hold pills morning of surgery, check blood glucose 

  • Type II diabetes, on insulin: fast, insulin dose depends on type (see below), start D5W infusion 

 

Crises

 

• Hyperglycemia (DKA, HONK)

• Hypoglycemia

 

 

Special populations

 

• Pregnancy:

  • ↑ risk of DKA, HONK, pregnancy-induced hypertension, difficult airway, aspiration, pre-term labor, cesarean section, polyhydramnios, postoperative infection

  • For fetus: 

    • Macrosomia (birth trauma, shoulder dystocia, cesarean section, postpartum hemorrhage)

    • Glucose regulation (hypoglycemia)

    • Congenital malformations (cardiovascular, CNS, GI)

    • Respiratory distress syndrome 

 

 

Insulin Management Guidelines (SAMBA Guidelines)

 

 

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