Diabetes and CAD
Anja Behringer reports on a neglected risk factor. With an aging population multimorbidity is increasingly a major challenge for hospital care. Diabetes is one of the medical conditions frequently encountered in multimorbid patients since cardiac and vascular diseases are often accompanied by dysfunctions of the blood sugar metabolism.
If diabetes is properly managed then surgery, even a major intervention, is not associated with an increased risk. This, however, is not the case when complications such as CAD, neuropathy and nephropathy are present. In any case, surgery for diabetics needs special preparation and precautions by both patient and surgeon. Since stress hormones are released during surgery, the blood sugar levels increase, which means higher insulin doses are necessary. If surgery is planned for a diabetic, preparation should begin a few weeks before.
• The surgery should be discussed with a diabetologist because adequate blood glucose levels reduce post-surgery wound healing complications and infections. HbA1c should not exceed 53 mmol/mol (7%).
• The anaesthetist needs information regarding the diabetes therapy, for example whether it is drug-based (if so which medication is administered) or insulin-based. Some oral diabetes medications (sulfonylurea and Metformin) must be discontinued two days before surgery, because under surgical conditions those drugs may cause dangerous lactic acidosis.
• During 12-hour fasting before surgery the insulin dose needs to be adjusted. During surgery an infusion of 5% glucose and minerals is provided separately from the insulin via an infusion pump. During and for some time after the intervention, blood glucose is measured in 30 to 90 minute intervals and the infusion pump is adjusted accordingly. After surgery the regular insulin or medication therapy is restarted with normal meals.
* The Silent Diabetes study was co-initiated by the Forschergruppe Diabetes e.V. at Helmholtz Centre in Munich, Germany, and supported by Roche Diagnostics, a researching company and market leader in in-vitro diagnostics
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