Role of Residents and Nurses in Perioperative Diabetes Management
Managing diabetes optimally in emergency or routine surgery is still a gray area. In patients who are critically ill, it is much more complex. Optimal control within limitations of surgical setting is rarely achieved in most places. Excessive or too frequent monitoring without dynamically changing plans for controlling the blood glucose to its optimal level is common. Optimal/tight blood glucose control leads to far better outcomes in all types of surgical settings . The primary reason for not undertaking aggressive management is the illogical fear of hypoglycemia and its consequences. The second is the inability to understand the relation between hyperglycemia in surgical setting and the causes leading to it. This in its turn leads to further indecisiveness about continuously altering the insulin administration to the dynamically changing causes. The third is the lack of knowledge of the pharmacokinetics and pharmacodynamics of administered insulin. Fourth is the high levels of insulin resistance that is obtained in these situations and how to break the resistance to achieve normoglycemia. Insulin resistance increases by seven- to eightfold in patients undergoing surgical procedures . All of these factors with many more lead to a state of continuous hyperglycemia.
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