Management of the diabetic in acute infections and surgical emergencies

Summary

To summarize then, it has been suggested that many of the surgical emergencies in the diabetic may be handled by the surgeon if certain fundamental principles of diabetic metabolism are recognized. Diabetes is a disease characterized by a state of insulin deficiency of greater or lesser degree and to avoid acidosis sufficient CH must be metabolized to avoid excessive catabolism of fat. The mild or well controlled diabetic satisfies the latter condition and therefore, minor procedures may be undertaken without further preparation. Infection in some manner not completely understood increases the insulin requirement of the diabetic and this must be taken into consideration in handling these conditions. Acidosis is a serious medical emergency and must be corrected before surgical intervention can be undertaken. Protamine zinc insulin has an important place in the treatment of acidosis in addition to its having largely replaced regular insulin in the management of the less severe surgical diabetic. And finally, the presence of diabetes in the patient should not permit us to overlook coexistent conditions which may, if not recognized, adversely affect the outcome for the diabetic patient facing a surgical emergency.