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Control of glucose levels in diabetics is difficult during illness and perioperatively; they are affected by counter-regulatory hormones, unpredictable eating, lack of exercise and many other factors. Tight control is important: it improves outcomes in critically ill patients and reduces infection rates. A variety of different methods have emerged to administer IV insulin, inculding fixed and variable rate insulin infusions. This chapter provides a tutorial on variable rate insulin infusions, including a worked example, what monitoring is required and possible pitfalls.
Managing diabetes during surgery is complex. Adverse outcomes associated with poor preoperative diabetes management includes higher morbidity and mortality, higher risk of diabetic ketoacidosis and hypoglycaemia, prolonged inpatient stay, and higher systemic and surgical complications. The author provides a detailed description of pre- and postoperative management of insulin- and noninsulin-dependent diabetic patients.
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