How To Achieve Optimal Perioperative Glycemic Control In Patients With Diabetes

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At present, there is no universally accepted perioperative protocol for glycemic control. This is largely attributed to the variety of treatments and level of customization required to optimize the patient.
Here one can see a postoperative infection that occurred after a patient with diabetes had undergone surgery for a chronic plantar foot ulcer. Researchers say hyperglycemia, especially blood glucose levels over 200 mg/dL, can increase the risk of post-op
How To Achieve Optimal Perioperative Glycemic Control In Patients With Diabetes
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Author(s): 
By Emily A. Cook, DPM, Jeremy J. Cook, DPM, and Barry I. Rosenblum, DPM

    Special circumstances, such as insulin pump management and IV insulin infusions, warrant further discussion and are beyond the scope of this article. In general, physicians maintain insulin pump use for these patients while they are inpatients and adjust this use as needed. If the patient is unable to manage the pump (due to illness, medications, anesthesia, etc.), then he or she will usually receive an insulin infusion or a calculated basal-bolus or subcutaneous insulin regimen.

In Summary

    This article gives a brief presentation on the perioperative glycemic controls we use at our institution. A well-considered protocol is important in delivering consistent quality care but each patient is unique in his or her metabolic needs, and requires careful scrutiny. If the complexity of your patient’s medical status exceeds your comfort level in managing the patient, we strongly advise having a medical or endocrinology consult to assist you.

    Dr. Emily Cook is a Chief Resident in the Division of Podiatry at Beth Israel Deaconess Medical Center in Boston and is a Clinical Fellow in Surgery at Harvard Medical School.

    Dr. Jeremy Cook is a Chief Resident in the Division of Podiatry at Beth Israel Deaconess Medical Center in Boston and is a Clinical Fellow in Surgery at Harvard Medical School.

    Dr. Rosenblum is Director of Podiatric Residency Training at Beth Israel Deaconess Medical Center in Boston, and an Assistant Clinical Professor of Surgery at Harvard Medical School.

    Dr. Steinberg (pictured at left) is an Associate Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.

    For related articles, see “Is Inhaled Insulin A Viable Alternative For Patients With Diabetes?” in the October 2006 issue of Podiatry Today or “A Guide To Nutritional Supplements For Patients With Diabetes” in the March 2006 issue.

    Also check out the archives at www.podiatrytoday.com.




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