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Diabetes Mellitus

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Perioperative Management of Diabetes Mellitus Amir B. Channa FFARCS, D.A. (Eng) KKUH - Riyadh
[object Object],[object Object],[object Object],Introduction
Introduction ,[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object]
Patients with diabetes: what pre-operative assessment is important? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Autonomic neuropathy increase risk of post op gastroparesis and urinary tract infection
Diabetic Acute Complications (1) Diabetic ketoacidosis. (2) (Hyperglycemic) hyperosmolarity non-ketotic states. (3) Hypoglycemia. Diabetic Chronic Complications (i) Macro-angiopathy (4) Cerebrovascular disease (5) Coronary heart disease: Asymptomatic ischemia (6) Peripheral vascular disease (ii) Micro-angiopathy (7) Retinopathy (8) Nephropathy (9) Neuropahthy Peripheral neuropathy Autonomic neuropathy (iii) (10) Diabetic foot infection
Long-term Complications of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term Complications of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term Complications of Diabetes Mellitus 10% of all diabetics develop renal disease usually resulting in dialysis Diabetics are up to 4 times more likely to have heart disease and up to 6 times more likely to have a stroke than a non-diabetic
Long-term Complications of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why is pre-op glycemic control important? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object]
Regulation of Glucose Insulin Glucagon Glucagon and Insulin are opposites (antagonists) of each other.
Endocrine Effects of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Endocrine Effects of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Endocrine Effects of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]
Etiological Classification ,[object Object],[object Object],[object Object]
Etiological Classification ,[object Object],[object Object]
Etiological Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiological Classification ,[object Object],[object Object],[object Object],[object Object]
Acute effects of hyperglycaemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chronic effects of Hyperglycaemia ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microvascular ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Autonomic Neuropathy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Autonomic Neuropathy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Peri-op problems ,[object Object],[object Object],[object Object],[object Object],[object Object]
Peri-operative goal ,[object Object],[object Object],[object Object]
How? ,[object Object],[object Object],[object Object]
Regimen depends on ,[object Object],[object Object],[object Object],[object Object]
Type II diabetes on diet alone ,[object Object],[object Object],[object Object]
Type II diabetes on oral hypoglycaemics ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
 
? Stop the OHA before surgery ,[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object]
Type I diabetes ,[object Object],[object Object]
Preoperative Insulin Traditional Approach ,[object Object],[object Object],[object Object]
Preoperative Insulin Continuous IV Infusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New insulin delivery modes ,[object Object],[object Object]
Minor surgery ,[object Object],[object Object],[object Object],[object Object]
Minor surgery ,[object Object],[object Object],[object Object]
Major surgery ,[object Object],[object Object],[object Object],[object Object]
Factors that need to be considered ,[object Object],[object Object],[object Object],[object Object]
Glucose ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Insulin ,[object Object],[object Object],[object Object],[object Object]
Insulin ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Potassium ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Fluids ,[object Object],[object Object]
Suggested GIK regimen ,[object Object],[object Object],[object Object],[object Object],[object Object]
Insulin infusion Blood sugar Insulin 5-10 mmol/l 2 U/hr (10ml/hr) 10-13 mmol/l 4 U/hr 13-16 mmol/l 6 U/hr 16-19 mmol/l 8 U/hr >19 mmol/l 10 U/hr
[object Object],[object Object]
A few anaesthetic considerations ,[object Object],[object Object],[object Object]
Regional anaesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Regional anaesthesia ,[object Object],[object Object],[object Object],[object Object]
General Anaesthesia ,[object Object],[object Object],[object Object]
General Anaesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object]
Diabetes Complications
[object Object],[object Object],DKA
Questions??????
Precipitating Causes ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology of DKA ,[object Object],[object Object],[object Object],[object Object]
Complications of DKA and clues to their development ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms of DKA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessment DKA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intervention ,[object Object],[object Object],[object Object],[object Object],[object Object]
Critical Monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object]
IV Fluids in DKA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Potassium Replacement in DKA ,[object Object],[object Object],[object Object]
Correct pH/Give Insulin ,[object Object],[object Object],[object Object],[object Object]
HHNK Hyperglycemic, Hyperosmolar Noketotic Syndrome ,[object Object],[object Object]
Factors Associated with HHNK ,[object Object],[object Object],[object Object],[object Object]
Four Major Clinical Features ,[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object]
Hypoglycemia ,[object Object]
Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms of Hypoglycemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diabetes in Pregnancy ,[object Object],[object Object],[object Object],[object Object]
Diabetes in Pregnancy ,[object Object],[object Object],[object Object],[object Object]
Diabetes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diabetes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Complications of Diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Complications ,[object Object],[object Object],[object Object]
Chronic Complications ,[object Object],[object Object],[object Object],[object Object]
Foot Infections with Diabetes ,[object Object],[object Object],[object Object]
Microvascular Complications ,[object Object],[object Object]
Visual Complications of Diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
THANK YOU !
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object]

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Diabetes Mellitus

  • 1. Perioperative Management of Diabetes Mellitus Amir B. Channa FFARCS, D.A. (Eng) KKUH - Riyadh
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  • 8. Diabetic Acute Complications (1) Diabetic ketoacidosis. (2) (Hyperglycemic) hyperosmolarity non-ketotic states. (3) Hypoglycemia. Diabetic Chronic Complications (i) Macro-angiopathy (4) Cerebrovascular disease (5) Coronary heart disease: Asymptomatic ischemia (6) Peripheral vascular disease (ii) Micro-angiopathy (7) Retinopathy (8) Nephropathy (9) Neuropahthy Peripheral neuropathy Autonomic neuropathy (iii) (10) Diabetic foot infection
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  • 11. Long-term Complications of Diabetes Mellitus 10% of all diabetics develop renal disease usually resulting in dialysis Diabetics are up to 4 times more likely to have heart disease and up to 6 times more likely to have a stroke than a non-diabetic
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  • 15. Regulation of Glucose Insulin Glucagon Glucagon and Insulin are opposites (antagonists) of each other.
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  • 62. Insulin infusion Blood sugar Insulin 5-10 mmol/l 2 U/hr (10ml/hr) 10-13 mmol/l 4 U/hr 13-16 mmol/l 6 U/hr 16-19 mmol/l 8 U/hr >19 mmol/l 10 U/hr
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