Principles of Care in the Diabetic Surgical Patient

Currently, around 37.3 million Americans—about one in ten—have diabetes, and about one in five people with diabetes do not know they have it. It is also estimated that 96 million are thought to have prediabetes. Diabetes is currently the eighth leading cause of death in the United States, while health care spending on diabetes is soaring with an estimate of $327 billion, of which 43% is spent on hospital care to treat diabetes and its complications. Patients with diabetes are frequently admitted to the hospital for surgical interventions. Common surgical reasons in relation to diabetes include diabetic foot problems, vascular surgeries, coronary artery bypass, kidney transplants, and eye surgeries. Meanwhile, patients with diabetes are frequently admitted for other surgical interventions unrelated to diabetes. During admission, diabetes management may vary based on the location of the patient, whether in surgical intensive care units (ICUs) or in regular wards. It also varies based on nutrition, whether it is regular oral feeding, enteral tube feeding, parenteral feeding, or just clear intravenous (IV) fluids. Good glycemic control shortens the length of hospital stay, lessens complications, reduces hospital mortality, and decreases hospitals’ 30- and 90-day readmission rates. While oral medications and/or insulin are commonly used to treat diabetes in outpatient settings, only insulin is recommended for treating diabetes during surgical admission. Insulin method of administration, insulin type, and dose vary significantly between patients. The use of steroids may complicate an insulin regimen. Patients on insulin infusion pumps also require specific consideration. The major risk of insulin use is hypoglycemia, which is infrequently severe. This chapter comprehensively covers the principles of diabetes management during hospital admission.