Diabetes y anestesia/Diabetes and anesthesia

Tratamiento actual y consideraciones anestésicas para la diabetes mellitus


Current therapeutic agents and anesthetic considerations for diabetes mellitus.
Kang H.
Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
Korean J Anesthesiol. 2012 Sep;63(3):195-202. doi: 10.4097/kjae.2012.63.3.195. Epub 2012 Sep 14.
Abstract
As the incidence of diabetes mellitus (DM) continues to increase worldwide, more diabetic patients will be presented for surgery and anesthesia. This increase of DM is a consequence of the rise in new patients of type 2 DM, and is likely attributable to rapid economic development, improved living standards, aging population, obesity, and lack of exercise. The primary goal of management in DM is to delay, or prevent the macro- and microvascular complications by achieving good glycemic control. More understanding of the pathophysiology of DM has contributed to the advance of new pharmacological approaches. In addition to the conventional therapy for DM, glucagon-like peptide-1 (GLP-1) mimetics, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), and insulin analogues are currently available effective hypoglycemic agents for the management of the patients with DM in the perioperative period and also consider the adverse effects of newly introduced agents that need more clinical observations.
KEYWORDS:
Anesthesia, Diabetes mellitus, Glucose, Hypoglycemia, Treatment

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460146/pdf/kjae-63-195.pdf



Guías para la inyección de insulina en el perioperatorio y en pacientes graves
Insulin injection guidelines for peri-operative and critically ill patients.
Bajwa SJ, Kalra S, Baruah M, Bajwa SK.
J Sci Soc [serial online] 2013 [cited 2013 Jul 23];40:68-75.

Abstract
Anesthesiologists and intensivists are encountering increasing number of diabetic patients in daily clinical practice. Majority of such patients may require insulin injections for control of hyperglycemia. Advancements in diabetes management have led to usage of newer insulin injections ranging from human insulin and insulin analogs to glucagon-like peptides-1 analogs. The adequacy of glycemic control and successful outcome with such therapeutic interventions depends upon the adoption of correct injection techniques and procedures. Peri-operative and critically ill diabetic patients are highly prone to develop acute complications of diabetes if appropriate therapeutic strategies are not formulated and implemented. As such, the in-depth knowledge and awareness about various injection technique guidelines is essential from the patient care and healthcare provider's perspective in the operative and critical care settings. This description is an abridged version of the Forum for Injection Techniques, India: The first Indian recommendations for best practice in insulin injection technique and their significance in peri-operative period and critically ill patients in intensive care units (ICU). These insulin injection techniques are based on evidence-based recommendations and are meant to improve the management of diabetes by the attending staff and physicians in operative and critical care arenas.
Keywords: Critically ill, diabetes, injection sites, insulin, insulin analogues, needle length, peri-operative, skin folds
http://www.jscisociety.com/text.asp?2013/40/2/68/115473



Una gran necesidad de conocimiento de las pautas de inyección de insulina en unidades de cuidados intensivos y operatorias.
An acute need for awareness of insulin injection guidelines in operative and intensive care units. Bajwa SJ, Kalra S, Baruah MP, Bajwa SK.
Anesth Essays Res [serial online] 2013 [cited 2013 Jul 23];7:1-3.

Abstract
The ever increasing number of peri-operative and critically ill diabetic patients in clinical settings have become a cause of serious concern. Invariably, such patients present with uncontrolled hyperglycemia which can be managed only with insulin therapy. [1],[2] Besides the existing challenges in the management of uncontrolled diabetes and its related complications, another difficulty which is commonly faced by the nursing staff and the physicians, is the lack of awareness regarding insulin injection techniques. Inappropriate insulin injection practices can lead to various clinical complications such as poor glycemic control, pain, bleeding and bruising, breaking and lodging of needle tip beneath the skin, contamination leading to infection, lipohypertrophy, and inaccurate dose administration


http://www.aeronline.org/text.asp?2013/7/1/1/113976



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